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.

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!

Wednesday, November 6, 2019

Healthcare Data Breaches Will Cost $4 Billion by End of 2019


Here’s some more interesting news on the entire IT problem that is faced by the healthcare sector these days.  I happen to love Black Book Market Research.  The company does a great job of staying on the leading edge of healthcare IT.  They recently released the following information which I think anyone involved with healthcare should read.  It doesn’t matter if you are a provider or an IT person, what Black Book has to say is pretty incredible… 

Read on:

Black Book Market Research LLC surveyed over 2,876 security professionals from 733 provider organizations to identify gaps, vulnerabilities and deficiencies that persist in keeping hospitals and physicians proverbial sitting ducks for data breaches and cyberattacks. 96% of IT professionals agreed with the sentiments that data attackers are outpacing their medical enterprises, holding providers at a disadvantage in responding to vulnerabilities.

A fragmented mix of 415 vendors offering data security services, core products and solutions, software, consulting and outsourcing received user feedback including large IT companies, mid and small security vendors and start-ups in the polling period Q4 2018 to Q3 2019.

Thus far in 2019, healthcare providers continued to be the most targeted organizations for industry cybersecurity breaches with nearly 4 out of 5 breaches, whereas successful attacks on health insurers and plans maintained with more sophisticated information security solutions with little change year to year. Over half (53%) of all provider breaches were caused by external hacking according to respondents.

Over 93% of healthcare organizations have experienced a data breach since Q3 2016 and 57% have had more than five data breaches during the same timeframe. Not only has the number of attacks increased; more than 300 million records have been stolen since 2015, affecting about one in every 10 healthcare consumers.

The dramatic rise in successful attacks by both criminal and nation-state-backed hackers illustrates how attractive and vulnerable these healthcare enterprises are to exploitation. Despite these wake-up calls, the provider sector remains exceedingly susceptible to ongoing breaches.

Budget constraints have encumbered the practice of replacing legacy software and devices, leaving enterprises more susceptible to attacks. “It is becoming increasingly difficult for hospitals to find the dollars to invest in an area that does not produce revenue,” said Doug Brown, founder of Black Book. According to 90% of hospital representatives surveyed, IT security budgets have remained level since 2016. As a percentage of IT health systems and hospital organizational budgets, cybersecurity has increased to about 6% of the total annual IT spend for CY 2020, however, physician organizations and groups report a decrease in actual cybersecurity expense allocated, with less than 1% of their IT budgets earmarked for cybersecurity in 2020.

A third of hospital executives that purchased cybersecurity solutions between 2016 and 2018 report they did so blindly without much vision or discernment. 92% of the data security product or service decisions since 2016 were made at the C level and failed to include any users or affected department managers in the cybersecurity purchasing decision. Only 4% of organizations had a steering committee to evaluate the impact of the cybersecurity investment.

“The situation did not improve in 2019 and dilemma with cybersecurity budgeting and forecasting is the lack of reliable historical data,” said Brown. “Cybersecurity is a newer line item for hospitals and physician enterprises and budgets have not evolved to cover the true scope of human capital and technology requirements yet, including AI.”

Last year’s Black Book cybersecurity survey revealed 84% of hospitals were operating without a dedicated security executive. As a solution to unsuccessfully recruiting a qualified healthcare chief information security officer, 21% of organizations opted for security outsourcing to partners and consultants or selected security-as-a-service options as a stop-gap measure.

In 2019, 21% of hospitals surveyed report having a dedicated security executive, although only 6% identified that individual as a Chief Information Security Officer or CISO. Only 1.5% of physician groups with over ten clinicians in the practice report having a dedicated CISO.

The estimated cost of a data breach by the respondent hospital organizations with actual breaches in 2019 averaged $423 per record.

In a separate Q3 2019 survey of 58 health system marketing leaders with organizational breaches in the past 18 months report expending between 51k and 100k dollars of unbudgeted marketing expense to fight any negative impressions on the hospital brand cast from data breaches and theft. Still, no marketing executive surveyed reported allocating 2020 budget funds to combat the consequences of patient privacy or record breaches.

That shortage of healthcare cybersecurity professionals is forcing a rush to acquire services and outsourcing at a pace six times more than cybersecurity products and software solutions, increased 40% from last year. Cybersecurity companies are responding to the labor crunch by offering healthcare providers and hospitals with a growing portfolio of managed services.

“The key place to start when choosing a cybersecurity vendor is to understand your threat landscape, understanding the type of services vendors offer and comparing that to your organization’s risk framework to select your best-suited vendor,” said Brown. “Healthcare organizations are also more prone to attacks than other industries because they persist at managing through breaches reactively and not proactively.”

The ability of non-CISO executives in healthcare organizations is not improving either. 70% of IT management respondents report their operations are not aware of the full variety of cybersecurity solution sets that exist, particularly mobile security environments, intrusion detection, attack prevention, forensics and testing. Last year 57% reported not having a good understanding of the cybersecurity product and service landscape.

58% of hospitals did not select their current security vendor in advance of a cybersecurity incident. 94% have not augmented their cybersecurity protections since their last breach. 35% of healthcare organizations did not scan for vulnerabilities before an attack.

“Providers are at a severe disadvantage when they are forced to hastily retain a cybersecurity firm in the midst of an ongoing incident as the ability to conduct the necessary due diligence is especially limited,” said Brown.

20% of healthcare organizations reported they felt intimidated by a vendor to retain services when the vendor identified a vulnerability or security flaw. “While the intrinsic nature of cybersecurity radiates pressures and urgency, hospitals shouldn’t let this dictate the vendor selection process,” said Brown.

On a positive note, 41% of healthcare enterprises have not formally identified specific security objectives and requirements in a strategic and tactical plan, improving from 60% in 2018. “Without a clear set of security goals, providers are operating in the dark and it's impossible to measure results,” said Brown.

87% of healthcare organizations have not had a cybersecurity drill with an incident response process, despite the skyrocketing cases of data breaches in the healthcare industry, and as of Q3 2019, 84% of hospitals and 65% of payer organizations did not have full-time cybersecurity employees.

27% of hospitals (up from 12% in 2018) believe that a Q3 2020 assessment of their cybersecurity will show improvement. 29% of hospital leaders believe their cybersecurity position will worsen and 79% of physician groups foresee increased cyber-attacks, as compared to 4% in other industries.

In 2019, 40% of providers surveyed still do not carry out measurable assessments of their cybersecurity status. Of those that did, 19% used an objective third-party service to benchmark their cybersecurity status, 7% used an objective software solution to benchmark their cybersecurity status and 73% self-assessed with their own criteria.

26% of hospital respondents and 93% of physician organizations currently report they do not have an adequate solution to instantly detect and respond to an organizational attack.

60% of surveyed CIOs did not evaluate the total cost of ownership (TCO) before making a commitment to sign their current cybersecurity solution or service contract. 91% reported they bought their cybersecurity solution to be compliant, not necessarily to reduce risk when the IT decision was made.

Healthcare organizations are hyper-focused on patient care and reimbursement. “Cybersecurity risks are not at the forefront of executives’ minds,” said Brown. “Medical and financial leaders also wield more influence over organizational budgets making it difficult for IT management to implement needed cybersecurity practices despite the existing environment.”

Tuesday, November 5, 2019

Medical Device Software VxWorks is Open to Hackers


One of the security problems we have in healthcare is the danger of proprietary or legacy software running devices that have a direct impact on patient care.  One of those systems that has come into the spotlight in 2019 is VxWorks which is developed by Wind River.  The software is something that runs in the background of many of the devices in our lives, however unlike major operating systems like iOS, Windows, or Android, many of us have never heard of it.  However, just because it manages things we don’t really pay much attention to doesn’t mean it is any less serious if it is engaged by hackers.

In this case VxWorks is currently running on 200 million (you read that right) devices and many of them are in the healthcare sector.  The company has stated it "can be found in surgical robots, infusion pumps, dialysis machines, pace maker programmers, assisted ventilators, etc. When critical Class III devices are being developed, and lives are at stake, medical device manufacturers have turned to Wind River. "

However, recently VxWorks has been in the news because of network vulnerabilities that could allow nefarious hacker types to break into it.  Because the code is used in so many specific devices, fixing it isn’t a simple matter.  Basically each device that uses it must be patched and it isn’t just a matter of a company setting up a patch which is then automatically downloaded and installed by every user.  In cases such as this, each unique end user would have to tell their devices to download and install the patch.  You can imagine the struggles of a company that manufactures surgical robots suddenly needing to update their operating system.  It could very well cause operational problems and/or affect patient care; and that is just one example.  Add to that the potential for FDA involvement and it is easy to see how big a problem something like this could turn out to be.

That sad part of this is that we have already seen that criminals don’t really care if patients and their lives are affected.  The Ransomware blitzkrieg we’ve seen in 2019 has shown in no uncertain terms that in the quest for money lives are not important to cyber criminals.

This isn’t meant to be an indictment of VxWorks, but it’s an example of how sideways things could potentially go with our dependency on life centric hardware.  I’m not currently aware of any dental devices affected, but that doesn’t mean there aren’t any.

If you would like to read more about the concerns the U.S. Government has on this situation, take a look at this page from the U.S. Department of Homeland Security.  

Monday, November 4, 2019

Coupled Electrophysiological, Hemodynamic, and Cerebrospinal Fluid Oscillations in Human Sleep


As someone who was diagnosed as a sufferer of Obstructive Sleep Apnea (OSA), I’ve become passionate about the importance of sleep and what a good night’s sleep can do for our bodies.

I’ve always been a Type A person and have pushed myself harder than necessary when it comes to sleep.  When I was younger, it was not uncommon for me to run on 4 to 6 hours of sleep on a regular basis.  My motto was a the ever popular “I’ll sleep when I’m dead”.  Unfortunately my ignorance of proper sleep eventually caught up with me.  This was especially true when I discovered that I had a genetically narrow airway.  Combining lack of proper sleep with the fact that even when I WAS sleeping I wasn’t getting restful sleep became a recipe for health problems later on.

Since I was diagnosed, I’ve taken a great interest in sleep and the importance of it for our overall health.

I recently came across a pretty interesting study about the movement of cerebrospinal fluid (CSF) during sleep.  It seems that while we sleep, our brain allows CSF to circulate more readily around the brain  and this allows different types of chemicals to be removed.  Many of these chemicals are one associated with memory problems.  The point being that even more information about sleep and its relation to health is being discovered.

The study is pretty fascinating reading.  It can be found at this link.  

Thursday, October 31, 2019

ADA Makes Their Position Known on Dental Care for Seniors


As our medical and healthcare system gets better and better, life expectancy AND quality of life continues to extend and improve.  However, with folks living longer, there is also the resultant problem of continuing with being able to function as we are accustomed to.

The problem for many is that they are now surviving longer than healthcare benefits were designed to last.  Actuarial tables are best guess estimates, but they are guesses none the less.  Because of that and the fact that many folks are going to need dental care throughout their extended lifespan, the American Dental Association made the current announcement today.  I feel it bears repeating here.  We *need* to take care of those who came before us.  We need to help those who are less fortunate and in need of our help.  I’m proud of the ADA for making their position known.

The American Dental Association has long recognized the importance of oral health care as a crucial part of overall health. For our senior population, those 65 and older, this statement is particularly relevant. Today's ADA strives to build upon previous leaders' efforts to educate and elevate this issue’s importance. Within the elderly cohort, who continues to expand numerically, it is imperative that the American Dental Association become the solution-based resource for this critical and time-sensitive issue.
The current discussions in Washington, DC, may have caught your attention. There are numerous House Bills attempting to add healthcare services to Medicare Parts A and B, and many include a dental benefit. The American Dental Association sees the pros and cons of individual aspects within these legislative bills, and we strive to yield positive results for both our members and the public.
Allow me to introduce the ADA Elder Care Workgroup.
The Current Landscape of Access to Dental Care for Seniors
Prior to introducing ADA efforts pertaining to elder oral care, it is useful to review the current landscape of dental care access for the elderly cohort. The ADA Health Policy Institute maintains the most robust data on the U.S. dental care system, drawing on publicly available as well as proprietary data sources.In 2018, the number of US citizens age 65 and over was 57 million, and that figure is anticipated to balloon to 84 million by 2050.

37% of seniors have some source of dental benefits coverage. Approximately 26% have private dental coverage, and 11% have public dental coverage (for example, Medicaid, Tricare, or the small number who receive dental benefits through Veterans Affairs).

63% of seniors do not have any form of dental benefits coverage.

What does coverage translate to in terms of oral health care use?43% of seniors had a general dental visit in 2016, up from 38% in 2000.

69% of seniors with private dental coverage had a dental visit in the past year.

16% of seniors with public dental coverage visited the dentist.

37% of seniors who are uninsured had a dental visit last year.

Dental care use also varies by household income.61% of seniors with household income above 400% of the federal poverty level visited the dentist.

24% of seniors with household income below 100% of the federal poverty level visited the dentist.

The disparities in dental care use and dental benefit coverage have clear implications for oral health. When it comes to various measures of seniors’ oral health, such as prevalence of untreated cavities or tooth loss, disparities by income, race, and dental insurance status are widening over time. That is, high-income seniors, in general, are seeing improvements in their oral health while for low-income seniors, improvements are either not as large or, in some cases, are non-existent.
The Time to Act is Now
As your president, I felt it was important that the ADA, as America's leading advocate for oral health, share this data with policymakerson the House Ways and Means Committee as they consider policy options to improve access to dental care among seniors, specifically through Medicare reform. Sharing data with policymakers in no way signals that the ADA supports any particular bill.

Data in and of itself is also not ADA policy. As a science-based organization, data is an extremely important input, but it is ultimately up to our esteemed House of Delegates to consider and vote upon resolutions to create ADA policy.

Looking back, the oral health success of Medicaid and CHIP for our youth has benefitted millions of young Americans. However, our elderly's oral health has not received the same discerning attention as our nation's children. This has been a widely discussed topic over the years within the ADA, and this topic's interest has escalated within the ADA House of Delegates over the past three years. In October, 2018, your ADA House of Delegates authorized Past President Dr. Jeffrey Cole to form the Elder Care Workgroup (ECW). Dr. Cole selected eleven dentists and one physician from varied backgrounds, and I reappointed the Elder Care Workgroup in September, 2019.

The Elder Care Workgroup felt strongly that in order for any dental program to be effective in improving the oral health of seniors and providing for their care, a robust network of providers is essential. If dentists are to be incentivized to enroll and provide care under a program, reimbursement must be at a level that accounts for the unique cost of dental care delivery.

After numerous meetings involving spirited, academic, informed and respectful debate, and secluded in their deliberations, The Elder Care Workgroup will present to the 2020 ADA House of Delegates a list of options. These options include a select portion of Center for Medicare and Medicaid Services (CMS) programs suitable for dentistry’s delivery model.

Thus, the Elder Care Workgroup has developed a multi-faceted approach, recognizing that the elder oral care issue's enormity requires innovative thinking. The ECW pursued solutions resulting in coverage for every elderly socio-economic level. The ECW's recommendations are not yet policy as the ADA House of Delegates has yet to vote. However, the ECW's work is progressing towards a presentable House of Delegates product next October.

I am proud to say that your ADA is on the leading edge of a solution, one involving private, non-profit and government programs.

The question is not, "should we do something." The question is, "how do we do it." The time to act is now.

Wednesday, October 30, 2019

Objective By the Sea Conference is Coming this Spring on Maui


If you are into security and especially security that revolves around all things Apple, it’s time to start preparing for Objective by the Sea Version 3.0

One of the things that helps me to stay on top of technology is a habit I’ve developed of nosing around the Internet and reading things that are in my areas of interest.  Of course when you’re me, that sphere of interest can be pretty large at times which means I sometimes lose myself in a multitude of pages dealing with a multitude of subjects.  To my benefit (and hopefully your’s occasionally) I go “down the rabbit hole” and find some pretty interesting things.  Not always, mind you, but often enough that I feel it pays off.

Two or three years ago I happened to stumble across an article on Apple security and it introduced me to a Mac security researcher by the name of Patrick Wardle.  He is a pretty interesting guy and very familiar with the security of the Apple Ecosystem.  His bio states:

Patrick Wardle is a Principal Security Researcher at Jamf and founder of Objective-See. Having worked at NASA and the NSA, as well as presented at countless security conferences, he is intimately familiar with aliens, spies, and talking nerdy. Patrick is passionate about all things related to macOS security and thus spends his days finding Apple 0days, analyzing macOS malware and writing free open-source security tools to protect Mac users.

When I learned about Patrick, I also learned that he writes code for apps that help keep your Mac secure.  I’ve been using them religiously ever since and have been really happy with them.  Obviously someone with the background that he has means his coding skills have been very well honed.  I’ve been impressed enough with him to become a Patreon supporter.

I was also impressed to learn that Patrick created a meeting called Objective by the Sea that deals with Apple security.  The event is now entering its third year and for anyone who is interested in coding and the security of the Apple Ecosystem, this is a meeting that I really think you should consider.  While the event is still in the planning stages as far as the venue is concerned, you can get overview details from the website.  Put this one on your calendars now if Maui in March 2020 seems like a good idea (and really, why wouldn’t it be?)  

Tuesday, October 29, 2019

Healthcare Security Breaches Focusing more on Social Engineering


One of the ways I try to keep up on things is by a voracious reading habit.  I’ve always had a love of gadgets and technology, but keeping up with the constant onslaught of information can be challenging for anyone.  I think this is especially true if the subject happens to be one you don’t have a tremendous interest in.  It’s probably not necessary to say this here, but I take a great responsibility in keeping you abreast of as much tech information as I can.

To help, whenever I hear of a report being released I grab it and try to digest it in a timely manner.  One of the things about technology is that if you don’t stay current, you’re moving backward.  Then trying to get back to a level playing field knowledge wise is even harder.

The thing I love about reports put together by experts is that they summarize things they are seeing and it helps get the message out more succinctly.  So I was excited when I learned that ProofPoint had released a new healthcare industry report on security.

Something that everyone in healthcare needs to be considering is that this is not just something that requires attention because we are trying to be HIPAA compliant.  Don’t get me wrong on that statement. Being in compliance with federal law is *extremely* important.  HIPAA violations can lead to serious fines that could cripple or end the life of a small practice.  However, today it’s not *just* about laws.  Security flaws and the disasters they bring can have as big an impact on the financial well being of a practice as federal fines.  If Ransomware locks you out of your database, your organization begins to hemorrhage money.  Not only are you not generating revenue, you are also paying experts to try to reconstruct your systems from the ground up.

There is also the aspect of the care of the patients.  If a practice goes down, or more importantly a hospital, the well being of patients is immediately at stake.  Lives may hang in the balance and that gets back to the Hippocratic Oath of “First of all, do no harm.”  If a patient cannot be treated appropriately this can have disastrous results.  Security is not a “good idea”, security is now one of the major tenets of healthcare.

What experts like ProofPoint are now discovering is that criminals are not just looking for ways to break into systems by computer hacking techniques.  Recently they have turned to social engineering tactics as well.  Here are 5 things they point out in their report:

  • Targeted healthcare companies received 43 imposter emails in first quarter of 2019, a whopping 300% jump over the same quarter last year. Within affected healthcare companies 65 people were targeted by spoofed email, and 95% of those companies saw emails spoofing their own trusted domains.
  • Subject lines that included “payment”, “request” “urgent” and related terms appeared in 55% of all imposter email attacks.
  • 77% of email attacks on healthcare companies used malicious URLs.
  • Banking Trojans were the biggest threat to healthcare companies over the period of our research.
  • Factors such as access to critical data or systems, having a public facing email, can make anyone a highly targeted person.

The lesson here is to pay close attention to the social engineering aspect of security now more than ever.

To learn more about what ProofPoint has discovered, follow this link.

Monday, October 28, 2019

Axsys Dental's Versamill 5X400 wii be Arriving Soon

I’m very excited for the arrival of the Versatile 5X400 by Axsys Dental.  This is a truly game changing 5 axis dental mill that is capable of producing practically any type of appliance or prosthetic that a dental office could need or prescribe.

When I first say a demonstration of the 5X400 I was delighted to see the amazing results the device is capable of.  It can mill zirconia, precious metals, titanium, glass ceramics (including lithium disilicate), models, clear aligners, occlusal guards, bridges, crowns, and more.

For years now the milling aspect of CAD/CAM has been limited to single units.  Since the majority (around 80%) of prosthetics in general dental practices are done as single units, this hasn’t been an incredible limiting factor.  However, offices that enjoyed the single visit aspect of CAD/CAM really had no choice but to opt for laboratory fabricated prosthetics when it came to bridges, custom abutments, etc.  Now, with the 5X400 those problem have been solved.  The mill can cut single units out of the “blocks” that offices are used to, while also taking advantage of milling from “pucks” for long spans and full arch appliances.  

The unit destined for my office is currently going through it’s final quality assurance testing and will be arriving soon.  We’re excited to begin implementing the system and evaluating the results.

Here are some of the basics from the company:

  • 5-Axis dental milling center capable of 5-Axis simultaneous machining  including undercuts.
  • Closed-loop position control assures accuracy and eliminates frequent machine calibrations.
  • Machine wide variety of materials - including: zirconia, glass-ceramics, wax, Ultimate, titanium* & more.
  • Ideal for the production of bridges, copings, inlays, onlays crowns, models, and more— even titanium abutments*.
  • Long tool life and superior surface finishes due to extreme stability and minimum vibration.
  • Flexible universal fixturing for quick adaption to different materials and restoration types.
  • Integrated HSM machine control.
  • Open architecture design compatible with industry standard software for easy integration into a complete manufacturing solution.

Needless to say I’ll be posting here and on my social media channels as the evaluation continues.  If you haven’t yet followed me on Twitter of Facebook, these links will get you there.

Thursday, October 24, 2019

Sugary Fruit Drinks for Children are Over Consumed and Unhealthy Despite Package Claims of "Real, Natural, and/or Organic"


According to the University of Connecticut’s Rudd Center for Food Policy and Obesity, U.S. children are continually increasing the amount of sugary drinks they consume and this is leading to obesity and disease later in life.  

The problem is that many parents see, hear, or read advertising claims and believe the claims at face value.  In reality the median juice content is only 5% while the median sugar amount is 16 grams (which is 1.25 tablespoons).  That’s a whopping amount of sugar for a drink in a “kid size” bottle.

It’s easy for a parent to look at something that is “fruit juice” and assume that because it is “fruit” that it has to be healthy for their children.  

The study has some incredibly enlightening information, such as the following:

One serving of 11 of the children’s fruit drinks analyzed had more than 50% of the recommended amount of daily added sugar for children (i.e., >12.5 g), including many of the highest-selling brands (Capri Sun Juice Drink, Hawaiian Punch, Sunny D, and Minute Maid Lemonade).

As most of us have realized, there is an obesity problem in the United States.  Not only can this affect children while they are still children, but this can continue to impact them as they grow into adulthood.  Heart disease, diabetes, many other diseases have direct link to obesity.  Unfortunately, branding drinks with incredibly high sugar content as “healthy” is neither *healthy* or truthful.  The Rudd Center report has some incredible statistics and I feel it bears reading even if you are not a parent of young children.

Wednesday, October 23, 2019

Patient Appreciation Pancake Breakfast


This past Saturday, our office hosted our Patient Appreciation Pancake Breakfast.  We like to do this event from time to time and it’s always a great time.  Despite a cool and rainy weather front, we had incredible attendance.  Pancakes and sausages were provided by local favorite Chris Cakes who were flipping pancakes and cooking sausages in the parking lot.

One of the great things about our office is that we have a large comfy reception area as well as a conference room so, even though the weather was damp and chilly, folks were eating warm and dry inside the building as well as a few brave souls who munched outside.

We recently completed the paperwork to absorb the patients of another local office as Dr. Jim Williams decided to retire and has entrusted the care of his patients to us.  It was a great way for some of Dr. Williams patients to come by, meet the staff, meet the doctors, and get a chance to see the office.

There’s just something about pancakes to start a Saturday off right and this was no exception.  Thanks to everyone who came by and helped make the event a success.  The gang at the office absolutely loves what we do and we couldn’t do it without all the patients who trust their care to us.  We are truly honored.

Tuesday, October 22, 2019

EPA Amalgam Separator Deadline Looms in the Near Future...


Every dental office will need to have an amalgam separator installed and in service by July 14, 2020 as mandated by the EPA.  Those that do not face fines to bring them into compliance.

While there are several companies in the market, my personal preference is DRNA (Dental Recycling North America).  The company provides a cost effective and turnkey solution to the amalgam separator requirement.  I've been using them for the past 5 years and have been very happy with the service.

According to the EPA:

If improperly managed by dental offices, dental amalgam waste can be released into the environment. Although most dental offices currently use some type of basic filtration system to reduce the amount of mercury solids passing into the sewer system, dental offices are the single largest source of mercury at sewage treatment plants.
The installation of amalgam separators, which catch and hold the excess amalgam waste coming from office spittoons, can further reduce discharges to wastewater. Without these separators, the excess amalgam waste will be released to the sewers.
From sewers, amalgam waste goes to publicly-owned treatment works (POTWs) Publicly-Owned Treatment WorksA water treatment facility, as defined by Section 212 of the Clean Water Act, that is used in the storage, treatment, recycling, and reclamation of municipal sewage or industrial wastes of a liquid nature, and is owned by a municipality or other governmental entity. It usually refers to sewage treatment plants. (sewage treatment plants). POTWs have around a 90% efficiency rate of removing amalgam from wastewaters.  Once removed, the amalgam waste becomes part of the POTW's sewage sludge, which is then disposed:
in landfills.  If the amalgam waste is sent to a landfill, the mercury may be released into the ground water or air.
through incineration.  If the mercury is incinerated, mercury may be emitted to the air from the incinerator stacks.
by applying the sludge to agricultural land as fertilizer.  if mercury-contaminated sludge is used as an agricultural fertilizer, some of the mercury used as fertilizer may also evaporate to the atmosphere.
Through precipitation, this airborne mercury eventually gets deposited onto water bodies, land and vegetation. Some dentists throw their excess amalgam into special medical waste containers, believing this to be an environmentally safe disposal practice. If waste amalgam is improperly disposed in medical waste bags, however, the amalgam waste may be incinerated and mercury may be emitted to the air from the incinerator stacks.  This airborne mercury is eventually deposited into water bodies and onto land. 

Thursday, October 17, 2019

Dentsply Sirona World 2019 proves again to be the dental industry’s must- attend educational event


As three days of unparalleled
educational opportunities and thrilling entertainment options
came to a close, attendees left the Mandalay Bay Resort and
Casino in Las Vegas understanding why Dentsply Sirona
World remains the premier dental event in the world.

“With more than 100 Breakout Sessions, rousing General
Sessions, top-tier entertainment and lively social activities,
Dentsply Sirona World proved why there is no equal to the
Ultimate Dental Meeting,” said Vice President of Marketing
Ingo Zimmer.

Held Oct. 3-5, attendees filled enlightening education sessions
taught by the biggest names in dentistry, got hands-on with
the most innovative technologies and products on the trade
show floor, experienced once-in-a-lifetime private shows from
the awarding-winning Zac Brown Band, iconic comedian Jerry
Seinfeld and so much more!

Continuing educational courses were offered in 12 specialized
tracks, a record for the event. Attendees had no shortage of
incredibly high-quality learning opportunities when they
personalized their schedules to meet their needs.

The General Sessions kept attendees on the edge of their
seats with inspiring speakers, including Dr. Mike Skramstad, Dr.
Rebecca Bockow, Imtiaz Manji, Dr. Shalin Shah, Amy Morgan,
Dr. Lyndon Cooper and one of the world’s top digital
strategists, Brendan Kane. Additionally, Dr. Meena Barsoum
and Dr. Tarun Agarwal performed live dental procedures.

Per usual, Dentsply Sirona World offered its guests the chance
to experience celebrity entertainment in a personal setting.
One of the top digital strategists in the world, Brendan Kane,
captivated the audience with this talk, sponsored by VITA,
during Friday’s general session, while legendary comedian
Jerry Seinfeld kept them laughing with his standup and the
crowd couldn’t stop dancing during the Grammy award
winning Zac Brown Band’s private concert.

Two wellness activities allowed attendees to better both their
minds and bodies, as Ivoclar Vivadent sponsored a pirate-
themed fun run and Solea sponsored a yoga class. Attendees
were in a jovial mood wearing their best pirate-inspired
costumes, as they made their way along the beautiful Las
Vegas Strip during Friday morning’s fun run. On Saturday,
guests looked inward and found their Zen during the Yoga
Session with Tara Jae.

The Bucca(l)neers’ Bash gathering was the perfect end to an
amazing three days in Las Vegas. Guests put on their eye
patches and hit the dance floor to socialize with their peers.
From the rousing band, to the tasty drinks and amazing pirate-
themed costumes, this party captured the true spirit of
Dentsply Sirona World.

Wednesday, October 16, 2019

The ADA’s Petition to FDA about SmileDirectClub is Still Active


Smile Direct Club is starting to take on water.  Take a look at this:

SmileDirectClub shares tumbled 13% on Monday, bringing their one-month loss to 46%, after California Gov. Gavin Newsom signed a bill into law that includes key changes in the regulation of the company’s “teledentistry” business model.  (MarketWatch)

Not to mention this headline:

SmileDirectClub is now the worst unicorn IPO of 2019, down nearly 60% from its debut (CNBC)

As Technology Evangelist, I am all about using tech to make the world, and especially health care, a better place.  However, I want it done *responsibly*, and from what I’ve gleaned about Smile Direct Club, it doesn’t meet that standard.

To make things worse for SDC (although worse is a relative term) the ADA (American Dental Association) has announced that they are also strongly opposed to the SDA model of treating patients.  To briefly summarize, SDC provides clear aligners with no physical exam from a doctor.  While in a few cases this might be feasible, I have seen many more cases in my career where a patient wants straighter teeth without realizing there are many factors that can compromise treatment.  Things such as active dental decay, periodontal disease, congenitally missing teeth, etc can greatly impact orthodontics and should be addressed and treated before even considering orthodontics.  

Here is the ADA’s latest announcement regarding this:

The American Dental Association (ADA) believes the public has a right to accurate information concerning the status of its pending  citizen petition submitted to the U.S. Food and Drug Administration (FDA) about SmileDirectClub, LLC’s direct-to-consumer plastic teeth aligner business. SmileDirectClub’s (SDC’s) inaccurate public statements that the ADA’s petition has been “shut down” or “dismissed” may deter customers who have experienced clinical problems in connection with SDC’s aligner “treatment therapy” from reporting their negative experiences to the FDA. 

SDC’s public misstatements, including in its Oct. 4 press release, are apparently based on a May 30, 2019 letter from the FDA to the ADA. The letter, which can be viewed at the citizen petition landing page, did not reject or dismiss any substantive aspect of the ADA’s citizen petition. The FDA’s letter explains:

“We appreciate the information [the ADA] provided. Such information is often helpful for us to identify problems with marketed products and possible violations of the laws and regulations that we enforce. We take complaints seriously and we will evaluate this matter to determine what follow-up action is appropriate.”

The letter further explains that the FDA does not initiate enforcement actions on behalf of petitioners. Instead, the FDA reviews the submitted evidence and decides for itself what action to take. All substantive issues raised by the ADA’s citizen petition remain fully before the FDA at this time. The comment period for the public to address the petition and for the ADA to supplement the petition is open until Oct. 22 at 11:59 pm.

Further proof of the continuing pendency of the ADA citizen petition is SDC’s acknowledgement of it in the “Risks Related to Legal and Regulatory Matters” section of SDC’s August 12, 2019 S-1 filing with the U.S. Securities and Exchange Commission. Had the FDA dismissed the ADA’s citizen petition, there would have been no reason for SDC to mention the petition in its securities filing, and certainly not to identify the regulatory proceeding as one of SDC’s existing “risks.” 

The ADA submitted its citizen petition and a complaint letter to the Federal Trade Commission’s (FTC) Bureau of Consumer Protection out of concern for public safety and customer recourse in the event of negative outcomes from SDC’s orthodontic “treatment therapy.” Plastic teeth aligners are designated by the FDA as a Class II medical device requiring a prescription. The ADA believes SDC is placing the public at risk by knowingly evading the FDA’s “by prescription only” restriction.

In lieu of having dentists review patient dental records or perform any sort of patient exam (whether using teledentistry or otherwise) before prescribing orthodontic treatment, SDC instead requires customers to self-report their dental condition. As the ADA explains in its citizen petition, customer self-reporting does not meet the applicable standard of care because it does not satisfy a dentist’s requisite professional due diligence. Put simply, SDC and the small number of “SDC-affiliated” dentists have no way of knowing whether a lay consumer’s self-reported dental condition is accurate, informed, or true in any respect. 

Moving teeth without knowing all aspects of a patient’s oral condition has the potential to cause bone loss, lost teeth, receding gums, bite problems, jaw pain, and other issues. Despite these potentially serious outcomes, SDC requires its customers to hold the company harmless from any negative consequences, as the ADA points out in its FDA citizen petition and FTC complaint letter.

In addition to these public health concerns, the ADA’s letter to the FTC cited various SDC practices the ADA believes to be deceptive under section 5 of the Federal Trade Commission Act, including:

Informing purchasers they have recourse against SDC via arbitration, when the same document includes a “small print” provision obligating the customer to waive any and all rights the customer “or any third party” may have against SmileDirectClub.

Soliciting customers by claiming that SDC aligners will correct their overbite, underbite, and crossbite conditions, or their “extreme” malocclusion. But after customers complain about poor clinical outcomes, SDC invokes other documents stating that its aligners cannot treat bite conditions at all and can only treat mild to moderate teeth misalignment, not “extreme” misalignment.

Claiming that SDC customers receive the same level of dental/orthodontic care as actual dental patients, when in fact SDC and its affiliated dentists provide virtually no care and, contrary to its claims, SDC does not use teledentistry.

The ADA considers it our public duty to make the relevant regulatory agencies aware of these facts, so those agencies can be fully informed and consider whatever actions they deem appropriate.

The FDA’s MedWatch voluntary reporting form may be used by both consumers and health care professionals to report poor clinical outcomes associated with medical devices, including plastic teeth aligners. The FTC also offers consumers an online form to report complaints about unfair and deceptive business practices on its website.

Tuesday, October 15, 2019

Ultradent Launches a VALO Curing Light into Space!!! And You Could Get a VALO for Only $0.99


There are some amazing things about Ultradent’s Valo curing light.  One of the most incredible is how durable it is.

The device is made out of aerospace grade aluminum which is the same aluminum used to make satellites, rockets, and missiles.  With that in mind, the smart and adventurous people at Ultradent had a great idea for the device’s 10 year anniversary.  That’s right, the first Valors hit the market in 2009.  To celebrate, they decided to actually launch a Valo into space!  Interested in seeing just how they did it? They have posted a video to FaceBook that shows the launch and even a brief “chase” by a drone.  

It’s not the easiest thing to do, getting something into space, but if something was easy, then the smart people at Ultradent wouldn’t do it!  I know these folks pretty well and I can say that those people love a good challenge.

So, they actually created a box carrying GoPro cameras, a Valo, and a bobble head of founder Dr Dan Fischer and attached the contraption to a weather balloon.  From the front lawn of Ultradent World Headquarters in South Jordan, Utah, the package was launched.  As you can see from the photo above, the project worked pretty well!  I do not know the final altitude that was achieved, but in the photo accompanying this post, you can see the curvature of the Earth.

Now if launching a curing light into space isn’t enough… the company has also announced a contest.  If you can guess where the Valo landed, you will be the proud owner of a Valo curing light for only 99¢!!!  That’s right, you can get the best curing light currently on the market for less than a buck.  Here is the link for the contest.  

Monday, October 14, 2019

Lung Injuries Due to Vaping Continue to be Reported


As almost everyone has heard, there has recently been a significant number of people afflicted with severe lung injuries apparently related to vaping.

While the exact cause is yet to be determined, it definitely appears to be caused by e-cigarettes.  The CDC (Center for Disease Control) has been investigating.  At this point, the CDC is strongly advising against using any of these products.  Now that the problems have come to the attention of federal agencies the investigations are progressing as fast as possible.

Here is what the CDC has stated as far as what they have so far determined:

  • As of October 8, 2019, 1,299* lung injury cases associated with the use of e-cigarette, or vaping, products have been reported to CDC from 49 states, the District of Columbia, and 1 U.S. territory.
  • Twenty-six deaths have been confirmed in 21 states.
  • All patients have reported a history of using e-cigarette, or vaping, products.
  • Most patients report a history of using tetrahydrocannabinol (THC)-containing products. The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak.
  • Therefore, CDC recommends that you should not use e-cigarette, or vaping, products that contain THC.
  • Exclusive use of nicotine containing products has been reported by some patients with lung injury cases, and many patients with lung injury report combined use of THC- and nicotine-containing products. Therefore, the possibility that nicotine-containing products play a role in this outbreak cannot be excluded.
  • At present, CDC continues to recommend that people consider refraining from using e-cigarette, or vaping, products that contain nicotine.

Here is what is NOT known:

  • At this time, FDA and CDC have not identified the cause or causes of the lung injuries in these cases, and the only commonality among all cases is that patients report the use of e-cigarette, or vaping, products.
  • This outbreak might have more than one cause, and many different substances and product sources are still under investigation. The specific chemical exposure(s) causing lung injuries associated with e-cigarette product use, or vaping, remains unknown at this time.

Obviously the safest thing to do is to immediately discontinue use of e-cigarette products.  However, human nature being what it is, the practice will most likely continue for the foreseeable future.  If you or anyone you know uses e-cigarettes and experiences any symptoms, seek medical help immediately.

Thursday, October 10, 2019

Emsisoft Releases *FREE* Decryption Tool for Muhstik Ransomware


As we all know, having a strong and reliable antivirus program running on your computers is incredibly important.  Connecting to the Internet without a reliable antivirus is simply asking for trouble and not worth the risk.  However, many users simply opt for one of the “big boys” of antivirus and don’t even consider alternatives.

The problem with some of the more well known AV programs on the market  is that they are rather process intensive.  This means they can sometimes slow your system down considerably.  The good news is that you are protected, the bad news is that your computer takes considerably longer to accomplish tasks.  Some of these AV suites also insert themselves so deep into your system that trying to removed them is almost impossible.  That means if you ever decide to go with another company, you may be unable to uninstall the current program.

That’s why I recommend researching and evaluating multiple vendors and not simply going with a company because everyone has heard of them.  There are several companies that provide very strong and reliable AV protection for a lower cost and don’t take over your system.

Some of these companies were started by individuals with strong backgrounds in Internet security and they continue to do research into security problems and even offer solutions.  One of those companies is Emsisoft.  The company provides a very robust and reliable AV suite that is rock solid and affordable.

I also love the fact that the company is giving back to the security field.  As you know, a lot of my interests lately have been focused on security and trying to help readers avoid that ravages of Ransomware.  Emsisoft recently released a FREE decryption tool for the Ransomeware variant called “Muhstik”.  For those affected by it, short of paying the ransom those affected don’t have much choice.  However as a way to help those affected, Emsisoft released the software at no charge, simply because helping is the right thing to do.

If you’ve been affected by Muhstik this is great news.  For those of you looking for a terrific AV product and would like to support a company committed to helping the industry, take a look at Emsisoft.

Wednesday, October 9, 2019

New Mid-ClassProsthetic Teeth LineDelivers Unprecedented Blend of Aesthetics, Easy Handling , Versatilityand Value


Kulzer’s Delara universal tooth line represents a new go-to option for labs

Kulzer, a global leader in dental materials,has announced the launch of its Delara tooth line, which sets a new standard for mid-priced prosthetic teeth by delivering modern layering, natural aesthetics, and easy handling. Like Kulzer’s Mondial, Mondial i, Artic and Basic prosthetic tooth lines, and in keeping with the company’s long-standing tradition of in-depth cooperation with dental professionals, the Delara line was developed by dental technicians for dental technicians.

Coming to market in the fourth quarter of 2019, Delara features 16 VITA shades and2 bleach shades (BL2 andBL3) in an optimized portfolio to meet universal needs. Its unique surface structure allows for natural light shattering and provides modern shading,as opposed to the dull appearance of some prosthetic tooth lines. Due to its easy processing characteristics, even dental technicians who make corrections can rest assured that Delara’s aesthetics and lifelike effect will not be lost. The teeth provide for lively transparency and successfully manage to avoid the undesirable grayor yellowish effect that can occur in the mouth with other products.

One tooth line that meets virtually every need

In addition to being visually impressive, Delara teeth offer a natural feel and excellent functionality. Technicians will appreciate the easy processing, while lab owners will appreciate great versatility and value. Dental labs that use it as their go-to line of prosthetic teeth will find that they are able to complete the majority of their restoration work more efficiently –with less need for grinding to adjust the shape –while still delivering quality restorations.

Dental laboratories will appreciate Delara’s many benefits, including:
•Beautiful, lifelike aesthetics:Modern, bright shading, dynamic light refraction from the vivid surface structure and anatomical forms give Delara a vibrant and fresh appearance.
•Easy handling for enhanced productivity:Simple setup with a polishing buffer,a basal grinding reserve, optimized incisal edges and reduced cusps for easy interlock create added efficiency and predictability for busy labs.
•Versatility:Various setup possibilities (from tooth-to-tooth to cross bite), CAD/ CAM production for easy integration into digital workflows,and great functionality meanDelara delivers as a universal, go-to line of prosthetic teeth.
•Excellent value:Agreat price-to-performance ratio that sets a new standard for prosthetics in the mid-priced segment–all with Kulzer quality and the excellent durability and comfort that patients can enjoy for a lifetime.

Due to its easy processing characteristics, even dental technicians who make corrections can rest assured that Delara’s aesthetics and lifelike effect will not be lost,” said Obie Clifford , Kulzer Product Manager.“The teeth provide for lively transparency and successfully manage to avoid the undesirable gray or yellowish effect that can occur in the mouth with other products.”

A rich history of prosthetic tooth innovation

A manufacturer of dental acrylics since the 1930s,Kulzerhas developed a tradition of quality, reliability, excellent aesthetics and innovation unmatched within the field of dental prosthetics. The company is particularly renowned for its expertise in balancing optimal functionality with the highest aesthetics.Kulzer prides itself on listening closely and regularly to its customers in order to ensure that its products perform exactly as dental technicians, dentists and their patients expect. To that end, the company develops all of its denture products, including its new Delara line, in close collaboration with internal and external dental technicians.

Tuesday, October 8, 2019

Ransomware Forces California Medical Practice to Cease Operations


For the last couple of years now I’ve been preaching the benefits of security from my pulpit of Technology Evangelist.

Some of you have reached out to me via electronic means to tell me basically “Flucke, I’ve got this covered.  I don’t need the expense of an outside service to run my backups.”  Honestly, I get that.  If you are a real die hard techie type, perhaps you have adequate systems in place.  The problem with these situations is that it’s hard to really be *totally* sure you have all of the systems in place because it is hard to predict what problems you’ll face and how many backups you might need to overcome that situation.  That’s why I’ve always referred to backups as “a backup chain”.  Simply because you need as many links as possible and it’s hard to judge how many links you’ll need.  The golden rule is that you need “one more copy than you think you need”.

Today, let me tell you about a medical practice in California.  Wood Ranch Medical, located in Simi Valley, California suffered a Ransomware attack on August 10, 2019.  While not many details on the attack and the ensuing restoration efforts have become public, this much is known.  The attack immediately encrypted the servers, the patient records, and the backup hard drives.  Evidently over a month was spent trying to fix the problem to no avail.  On September 18, 2019 the practice announced on their website that they could not recover the data and with the backup drives also encrypted they cannot rebuild the medical records.  Basically every piece of data was lost.  Since there is no data left to run the business with, Wood Ranch announced they will be closing the practice permanently as of December 17, 2019.

You read that correctly.  The practice was so devastated by the RansomWare that they are ceasing operations and are closing.  Without being aware of all of the things that transpired behind the scenes, it is difficult to know exactly what happened and exactly how it happened.  Looking back on this situation now, I would be willing to wager that what seemed like an unneeded expense for professional backups now seems like a bargain to the practice.  It’s like that with a lot of things.  Sometimes the price seems high until you are actually faced with the prospect, and the costs, of recovering.

I do not receive a check from DDS Rescue & I want you to know that.  I recommend them because I use them, I believe in them, and I know that they would have been able to get this practice back up and running, perhaps in as little as ONE day.  The money spent for their service should be looked upon as insurance.  RansomWare has stolen a doctors dream from them.  Don’t let this happen to you.

Monday, October 7, 2019

Mysterious iOS Attack Changes Everything We Know About iPhone Hacking


As most of you know, I take security very seriously and I try hard to get the rest of you to do so as well.  Sometimes my efforts are to protect patient data and keep practitioners out of trouble with enforcement entities.  However other times my efforts are to keep YOUR personal data out of the hands of nefarious types who will use it against you for God knows what.

*This is one of those posts.*  I have been exploring the subject of this post for a few weeks now through multiple sources and I have determined that anyone with an iPhone needs to be aware of this.  Wired magazine is not the only entity to be getting the word out, but I think the following article does a tremendous job.

Here is what Wired has posted.  If you are an iPhone user *this is required reading*!!!

Hacking the iPhone has long been considered a rarified endeavor, undertaken by sophisticated nation-states against only their most high-value targets. But a discovery by a group of Google researchers has turned that notion on its head: For two years, someone has been exploiting a rich collection of iPhone vulnerabilities with anything but restraint or careful targeting. And they've indiscriminately hacked thousands of iPhones just by getting them to visit a website.
On Thursday evening, Google's Project Zero security research team revealed a broad campaign of iPhone hacking. A handful of websites in the wild had assembled five so-called exploit chains—tools that link together security vulnerabilities, allowing a hacker to penetrate each layer of iOS digital protections. The rare and intricate chains of code took advantage of a total of 14 security flaws, targeting everything from the browser's "sandbox" isolation mechanism to the core of the operating system known as the kernel, ultimately gaining complete control over the phone.
They were also used anything but sparingly. Google's researchers say the malicious sites were programmed to assess devices that loaded them, and to compromise them with powerful monitoring malware if possible. Almost every version of iOS 10 through iOS 12 was potentially vulnerable. The sites were active since at least 2017, and had thousands of visitors per week.
"This is terrifying," says Thomas Reed, a Mac and mobile malware research specialist at the security firm Malwarebytes. "We’re used to iPhone infections being targeted attacks carried out by nation-state adversaries. The idea that someone was infecting all iPhones that visited certain sites is chilling."

This is just the first few paragraphs.  To access the rest of the article you NEED to follow this link.

Thursday, October 3, 2019

American Dental Association Expands Policy on Oral Cancer Detection to Include Oropharyngeal Cancer


As regular readers of the blog know, I’m extremely passionate about the detection of cancers of the head and neck.  Not only are these diseases life threatening, survivors are often left to deal with permanent disfigurement from surgeries.  For that reason, in my office every patient receives an oral cancer screening at every recare appointment.

The numbers dealing with these diseases are staggering.  Over 35,000 cases are diagnosed each year.  Of those diagnosed only 50% survive over 5 years.  More people in the United States die of oral and pharyngeal cancer than of cervical cancer.  Due to causation by the HPV 16 virus, those being diagnosed are young… many in their 20’s.  I could go on further, but I think you get the idea.  Dentistry needs to do all it can to help detect this threat at its earliest stages.

I’m a proud member of the American Dental Association and I am *really* proud of the organization’s stance and position on oral cancer.  At the most recent ADA meeting in San Francisco a few weeks ago the organization expanded its policy on the disease.  Here is the latest:

The American Dental Association recommends dentists conduct routine visual and tactile examinations for oral and oropharyngeal cancer for all patients, according to a resolution passed by the ADA House of Delegates on Sept. 9.

Resolution 65H-2019 amended the ADA policy on early detection and prevention of oral cancer to include oropharyngeal cancer and cover all patients, not just those previously thought to be at an increased risk because of tobacco and alcohol use.

"The revised policy aligns our statement with Centers for Disease Control and Prevention guidelines on visual and tactile examination and screening for oral and oropharyngeal cancers and highlights dentists' critical role in cancer screening and prevention," said Dr. Maria Geisinger, chair of the ADA Council on Scientific Affairs, which was charged with reviewing the policy and recommending changes.

The amendments also align with the ADA policy approved by the House of Delegates in October 2018 that supports the use and administration of the human papillomavirus vaccine. The CDC estimates 70% of oropharyngeal cancers in the United States are associated with HPV.

A research article published in August by the American Journal of Preventive Medicine found that in the 2011-16 National Health and Nutrition Examination Survey, only about one-third of U.S. adults 30 and older who had visited a dental practice within the last two years reported receiving an oral cancer screening exam.

In addition, survey data showed disparities based on demographics, with individuals who were a racial/ethnic minority, low income, less educated and uninsured or publicly insured less likely to be screened for oral cancer than those who were white and non-Hispanic, high income, more educated and privately insured.

"These patients are at a higher risk of developing oral cancer. The lower probability of dental professionals to screen these individuals represents a missed opportunity for early detection and improved outcomes of oral cancer," said Dr. Alessandro Villa, an assistant professor at the Harvard School of Dental Medicine and associate surgeon at Brigham and Women's Hospital, who co-authored the article and has worked with the ADA on HPV and oral cancer initiatives.

The disparities could indicate poor compliance with the current oral cancer screening guidelines and highlight possible selection of patients by dentists based on their socioeconomic status, but the findings also could be explained by some patient groups' lack of access to dental professionals with the time and training to provide oral cancer screenings, Dr. Villa said, adding more research is needed to understand the factors that limit an equitable delivery of the recommended screening.

"Every patient should be screened by their dentist and dental hygienist for possible early signs and symptoms of oral cancer, including the HPV-associated oropharyngeal ones," he said. "Efforts should be directed towards the education of patients about requesting an oral cancer screening in the dental office, and adequate training of the dental professionals on culturally sensitive communications might be an effective means to increase oral cancer screening exams among minorities and high-risk patients."

The full resolution will be available to members by the end of the year in the ADA Current Policies document at ADA.org/en/advocacy/current-policies.