Thursday, January 30, 2020

More Ransomeware Perpetrators Release Stolen Data to Force Payments


A couple of weeks ago, I made a post regarding how some Ransomware hackers were threatening to release stolen data as a way to compound victims fears and force them to pay.  Many organizations and law enforcement agencies were arguing *against* paying ransom as they that simply encouraged more attacks.  Also victims who had good backups could simply reformat their hard drives and install those good backups instead of paying.

To combat both of those strategies, Ransomware criminals began to first copy and steal data from victims prior to encrypting the victim’s drives.  The Ransomware proves that the system was compromised and the criminals then threaten to release all the stolen data so that it can be found and viewed by anyone with an Internet connection.

Website Ars Technica has been following this situation closely and is reporting that a criminal group, The Maze Ransomware Ring, has begun publicly posting breached data on the Internet.

At the latest count, around 25 different victims are being listed on The Maze website with small glimpses of the data that was stolen.

The idea of course is to force payment.  As I am typing this, I’m currently unaware of any reliable solution to this problem short of not having it happen in the first place.  Of course the problem here is that, like my grandfather used to say, “locks keep honest people honest”.  Most vulnerabilities are only discovered *after* someone exploits them and they are patched accordingly.  The best advice I can give here is to patch your systems as soon as updates are released and to have you and your employees be aware of social engineering tactics that can be used to gain access to your data.

Wednesday, January 29, 2020

Announcement from the ADA, Organization Adopts Interim Policy on Vaping


For those of us in healthcare, many have been following the progression of what I refer to as the “Vaping Problem”.  I knew that this was getting serious when the CDC created a name for the disease, calling it EVALI ((e-cigarette Vaping Aassociated Ling Injury).

The good news is that the CDC is reporting that emergency department visits related to this situation are continuing to decline.  This is probably at least in part due to the amount of press coverage this health scare caused.  Score one for the press.

Now, comes the latest announcement on the situation from the American Dental Association.  The following letter was sent to all ADA members:

As trusted health professionals, we have a responsibility to keep our patients safe from products that could cause harm. The American Dental Association also works to provide its members and the entire dental profession with clinical information that can guide patient care.

The health care community continues to learn more about the overall health risks of vaping. With regard to the oral cavity, preliminary research—while extremely limited—suggests potential concerns related to caries, periodontal disease, and oral cancer. The forthcoming April 2020 issue of the Journal of the American Dental Association will feature commentary supported by these early findings and highlight the state of the evidence on vaping and oral health.

Historically, the ADA has long opposed the use of any tobacco product, and encourages any tobacco users to quit by using FDA-approved cessation methods. In line with this stance, and as federal agencies continue to investigate vaping’s implications for public health, the ADA has adopted an ad interim policy on vaping, calling for a total ban on vaping products that aren’t approved by the Food and Drug Administration (FDA) for tobacco cessation purposes. 

The policy, adopted in December 2019, states that the ADA willUrgently advocate for regulatory, legislative, and/or legal action at the federal and/or state levels to ban the sale and distribution of all e-cigarette and vaping products, with the exception of those approved by the FDA for tobacco cessation purposes and made available by prescription only; and
Advocate for research funding to study the safety and effectiveness of e-cigarettes and vaping products for tobacco cessation purposes and their effects on the oral cavity.
This interim policy is consistent with several major health organizations, including the American Medical Association and the U.S. Centers for Disease Control and Prevention, which notes that all tobacco products, including e-cigarettes, carry risk. Its adoption comes on the heels of an ADA House of Delegates resolution indicating that the word “vaping” and any other alternative nicotine delivery systems be added to the existing ADA policy focused on tobacco-use prevention, research, and regulation.

Adopting this interim policy is a major step in protecting our patients as we explore the long-term impact of vaping on oral health and overall wellbeing. As we advocate for continued research and public health campaigns on the potential risks of vaping on the oral cavity, you, as ADA members, can help to support those efforts by reporting potential vaping-related concerns and oral health issues using the FDA’s safety reporting portal. In the meantime, information on the ADA’s efforts around vaping, including member resources, can be found at

As always, I welcome your thoughts. Send me your comments and suggestions at 

Tuesday, January 28, 2020

Healthcare May be Evolving Past Lead Aprons for X-rays


For decades patients have been covered with “lead aprons” when x-rays are taken.  The procedure has become so commonplace and expected that if they don’t see an apron when receiving x-rays, the majority of patients will ask about it.

The reasoning and philosophy regarding these aprons has always been about patient safety.  Early in the development of clinical radiology researchers determined that some tissues (reproductive and fetal tissues as an example) have higher x-ray absorption rates than other tissues.  The thinking was that since these tissues had greater absorption, it would be wise to shield them from x-ray exposure, thus lessening the possibility of damage during radiography.  To reduce this exposure, areas that were not receiving diagnostic x-rays were covered by a flexible lead shield.

However, shielding is a decades old practice that fails to take into consideration changes in imaging technologies and a greater understanding of how radiation behaves in the human body.  The biggest concern is “scatter”.  When x-rays enter the body, some of them do not pass straight through to the other side, but actually sort of “splay out” as they pass through.  These “scatters” might normally exit the body but instead are held in and bounce around more due to bouncing off the lead shield and going back into the body.  In these cases, lead shielding might actually increase the danger.  

There is also the amount of change that has come to the science of creating diagnostic imaging with x-rays.  Just as cameras and monitors have increased in their accuracy and how they produce images, x-ray projectors/generators  (the “camera” that produces the x-ray) have also evolved immensely.  The beam is much more focused with a *much* higher percentage of the radiation actually creating the diagnostic image with much less scatter.  Because of that, there is less scatter to be concerned with.

While the practice of draping will most likely be slow to disappear, look for it to wane in the future...

Here is the statement from the American Association of Physicists in Medicine:

PP 32-A
AAPM Position Statement on the Use of Patient Gonadal and Fetal Shielding
Policy source
April 2-3, 2019 Board of Directors Meeting Minutes

Policy text

Patient gonadal and fetal shielding during X-ray based diagnostic imaging should be discontinued as routine practice. Patient shielding may jeopardize the benefits of undergoing radiological imaging. Use of these shields during X-ray based diagnostic imaging may obscure anatomic information or interfere with the automatic exposure control of the imaging system. These effects can compromise the diagnostic efficacy of the exam, or actually result in an increase in the patient’s radiation dose. Because of these risks and the minimal to nonexistent benefit associated with fetal and gonadal shielding, AAPM recommends that the use of such shielding should be discontinued.
For patients or guardians experiencing fear and anxiety about radiation exposure, the use of gonadal or fetal shielding may calm and comfort the patient enough to improve the exam outcome (1). This may be considered when developing shielding policies and procedures. However, blanket statements requiring the use of such shielding are not supported by current evidence (2-4). Additionally, the AAPM recommends that radiologic technologist educational programs (including patient outreach efforts) provide information about the limited utility and potential drawbacks of gonadal and fetal shielding.

Rationale for policy: Gonadal and fetal shielding in X-ray imaging has for decades been considered consistent with the ALARA principle and therefore good practice. Given advances in technology and current evidence of radiation exposure risks, the AAPM has reconsidered the effectiveness of gonadal and fetal shielding.

Gonadal and fetal shielding provide negligible, or no, benefit to patients’ health.

1) Radiation doses used in diagnostic imaging are not associated with measurable harm to the gonads or fetus. The main concern with radiation exposure to the reproductive organs has been an increased risk of hereditary effects. However, according to the 2007 Publication 103 of the International Commission on Radiological Protection (ICRP), “no human studies provide direct evidence of a radiation-associated excess of heritable disease” (5). Similarly, the American College of Obstetricians and Gynecologists (ACOG) Guidelines, with endorsement from the American College of Radiology (ACR), states that “with few exceptions, radiation exposure through radiography, computed tomography scan, or nuclear medicine imaging techniques is at a dose much lower than the exposure associated with fetal harm” (6).

2) Patient shielding is ineffective in reducing internal scatter. In medical x-ray imaging, the main source of radiation dose to internal organs that are outside the imaging field of view is x-rays that scatter inside the body. However, surface shielding covering these organs has no impact on this scatter.

The use of gonadal and fetal shielding can negatively affect the efficacy of the exam.

1) Shielding can obscure anatomy, resulting in a repeated exam or compromised diagnostic information. Shielding placed inside the imaging field of view, or shielding that moves into the imaging field of view, can obscure important anatomy or pathology, or introduce artifacts. In such cases, if the procedure is not repeated the interpreting physician may lack important diagnostic information; if it is repeated, there will be a substantial increase in dose. Evidence shows that this is a more common problem than usually assumed (7-9).

2) Shielding can negatively affect automatic exposure control and image quality. All modern X-ray imaging systems use automatic exposure control, and the presence of shielding in the imaging field of view can drastically increase X-ray output, increasing patient radiation dose and degrading image quality (10).

ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Adolescents and Women with Ionizing Radiation. Resolution 39 (2018).
RM Marsh and MS Silosky. Patient shielding in diagnostic imaging: Discontinuing a Legacy Practice (2019) AJR; 212:1-3.
L Yu, MR Bruesewitz, TJ Vrieze, CH McCollough. Lead shielding in pediatric chest CT: Effect of apron placement outside the scan volume on radiation dose reduction (2019) AJR;212(1):151-156.
KJ Strauss, EL Gingold, DP Frush. Reconsidering the Value of Gonadal Shielding During Abdominal/Pelvic Radiography (2017) JACR;14(12):1635-1636.
ICRP, 2007. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann. ICRP 37.
Committee opinion no. 723: Guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130(4):933-934.
SL Fawcett and SJ Barter. The use of gonad shielding in paediatric hip and pelvis radiographs (2009) BJR; 82: 363-370.
MJ Frantzen, S Robben, AA Postma, et al. Gonad shielding in paediatric pelvic radiography: disadvantages prevail over benefit (2012) Imaging Insights; 3(1): 23-32.
MC Lee, J Lloyd, MJ Solomito. Poor utility of gonadal shielding for pediatric pelvic radiographs (2017) Orthopedics; 40(4): e623-e627.
ACR-AAPM-SIIM-SPR Practice Parameter for Digital Radiography. Resolution 40 (2017).

Support and Endorsement of this Position Statement from Other Groups:

American College of Radiology (ACR)
Australasian College of Physical Scientists & Engineers in Medicine (ACPSEM)
Canadian Association of Radiologists (CAR)
Canadian Organization of Medical Physicists (COMP)
Health Physics Society (HPS)
Image Gently
Radiological Society of North America (RSNA)
   See also: Imaging During Pregnancy

Monday, January 27, 2020

SmileDirectClub is Using Legal Shenanigans to Stop Bad Online Reviews


I’ve never been a fan of “do it yourself healthcare”.  My grandpa Flucke used to always say, “Experience is what you get 5 seconds after you needed it in the first place.”  My grandpa wasn’t in healthcare, but he was a pretty smart guy when it came to knowing his limitations.  He ran a chain of small grocery stores in the Kansas City area and was pretty successful at it.  His philosophy was: work hard, do your best, treat your customers they way you want to be treated.

My grandpa could’ve taught a lot of people how to run a successful business… and one of them is Smile Direct Club.

SDC has a business model of DTC (Direct To Consumer) orthodontics.  Basically the process is for a patient to take their own impressions, send them in to the company, and the company then sends back tooth moving aligners.  In *some* cases teeth are scanned in a retail outlet to replace the impressions.

The real problem is that as the treatment progresses, there is NO doctor involved.  Experience is HUGE in healthcare.  Not having a doctor involved in the treatment progression is begging to have things go off the rails.

Now comes news that when things DO go off the rails, the only way you get your money back is by  removing all negative comments from social media AND signing an ironclad agreement stating you will not say anything about the company.  That’s a heck of a way to prove your commitment to patient satisfaction.  And there is no need to take my word for it, you can read about it online via The Verge and the New York Times.

Part of the non-disclosure that was included in the New York Times article states “will not make, publish, or communicate any statements or opinions that would disparage, create a negative impression of, or in any way be harmful to the business or business reputation of SDC or its affiliates or their respective employees, officers, directors, products, or services.”  Maybe it’s just me, but that sounds like a company that wants to control you AND might just have something to hide.

SDC has done a lot of marketing around the idea that doctors are costly and not needed to perform the treatment, but I’ve never heard of doctor’s requiring non-disclosure agreements when things don’t work out.  Anyone who uses their legal team to force you to keep quiet… well that’s not the kind of company I’d want to do business with, let alone let them change parts of my body.

Thursday, January 23, 2020

Don't Be Like Jeff Bezos...


By now you’ve probably heard about the incredible hack of Jeff Bezos’s iPhone.  If you haven’t, let me give you a quick rundown of what took place...

It seems that in 2018, Jeff Bezos (the owner of Amazon and currently the world’s richest individual) met with the Crown Prince of Saudi Arabia Mohammad bin Salman bin Abdulaziz bin Abdul Rahman bin Faisal bin Turki bin Abdullah bin Mohammed bin Saud, who goes by the initials MBS.  At this meeting the two men exchanged info on how to contact each other via the encrypted chat application named WhatsApp.

WhatsApp is one of the most popular texting applications in the world due to its security.  Texts are encrypted from the moment they leave a user’s phone can only be de-crypted by the recipient’s phone.  Even the people who work at WhatsApp cannot break the encryption and read the messages.  Because of this amazingly strong encryption protocol, WhatsApp is incredibly popular, used by an estimated 1.5 billion people.

It is a well known fact that MBS uses it and the he frequently keeps in personal contact with world leaders through text messages.  So… to Jeff Bezos, exchanging WhatsApp contact info probably seemed like a normal and even smart thing to do, giving him direct access with one of the world’s most powerful leaders.

Later in 2018, the journalist Jamal Khashoggi was murdered.  It was soon determined that Mr. Khashoggi was killed by Saudi intelligence with the direct authorization of MBS.  Mr. Khashoggi was a journalist for the Washington Post and a Saudi citizen who was extremely critical of the government of Saudi Arabia and MBS in particular.  The theory is that he was murdered to silence him and his popular criticisms of the Saudi political system.

Jeff Bezos, in addition to owning Amazon, also owns the Washington Post which, interestingly enough, is the paper where Jamal Khashoggi worked.

The plot thickens...

In May of 2018 Bezos and MBS were engaged in a seemingly friendly WhatsApp exchange when a video file was sent from the prince to Bezos.  Unbeknownst to Bezos, the video file also contained malicious instructions that allowed for remote access to the phone.

Within hours huge amounts of data were transmitted from the phone to an unknown location dictated by the malware in the video file.  Mr. Bezos was unaware of the data transfer and had no idea anything was amiss.  No one seems to know where the information was sent or how it was used.  What IS known is that the breach happened pretty much as soon as the video file arrived on the phone.  This was NOT a failure of WhatsApp.  The encryption worked just fine.  It was the video file and the malware it contained that caused the problem.

This kind of thing has been known to happen in the Middle East before.  If you are interested type “Project Raven” into Google and see what happens.

Could Jeff Bezos have prevented this?  Maybe.  It always pays to not open things you get from others, but when it is someone you know & trust, it’s a lot harder to do that.  Also there are security apps that will scan things, but in order for it to be detected the malware needs to have been identified and added to the scanning database.  If it is something knows about, the chances of detection drops precipitously.

Wednesday, January 22, 2020

The Almost Invincible Lithium-Ion Battery


You may remember a few years ago, during the craze of the cheap hoverboards, that the dangers of Lithium-ion batteries began to appear.

It seems that one of the things that, at the time, was causing expensive gadgets to be, well expensive, was the price of the battery that powered said gadget.  However, the manufacturing boom in countries that had lower costs suddenly meant that expensive batteries were no longer so expensive.  Unfortunately the quality control also wasn’t as good. 

Suddenly batteries were exploding and catching fire which created huge scares and also damage.

To this day, many times as you check a bag at the airport they will ask if you have a lithium ion battery in there.

Now comes word that researchers at the Johns Hopkins Applied Physics Laboratory have been hard a work to create a Lithium-ion battery that can take a licking and keep your gadgets ticking.  Their success means a battery that can be cut, shot, bent, and soaked without an interruption in power.  It’s also an incredible material.  It is clear, non-flammable, and doesn’t need to be wrapped in a hard plastic case.

One of the best things is that it is based on water… that’s right water.  I love the fact that fire and water don’t usually mix very well, so the safety is sort of “built in”.

This could very well be the future in many of our gadgets and let’s face it, safety is a huge deal for battery operated gear.

Tuesday, January 21, 2020

The Science of How to Properly Board a Plane


I love Wired magazine.  The publication has been around since the early 90’s and I’ve been reading it pretty much since Day One.  There is always some good tech and geeky info there to digest and learn from.

Along those lines an incredibly interesting article where physicists have actually analyzed the boarding process of commercial airlines and come up with most efficient way to have the passengers board.  The group actually utilized some work from Einstein and some particle physics science to reach the conclusion… that stuff I find fascinating.

I travel quite a bit for lectures and meetings so that means that over my career I’ve spent a fair amount of my time in airports.  The boarding process has always seemed like watching paint dry to me because I am way too Type A for that type of thing.

I’m not sure how many airlines actually utilize the system that is spelled out here, but I’ve got to think this is no industry secret.  If you’d like to read the piece you can follow this link over to Wired.  

Monday, January 20, 2020

Dental Lab Products Returns!


Dental Lab Products® (DLP), the sister editorial resource to Dental Products Report® (DPR), is returning as a product-centered, techniques-based publication, steering lab businesses toward success in the dental community.

“We are very excited to relaunch Dental Lab Products®, an integral resource for dental lab professionals,” said Mike Hennessy Jr., president and CEO of MJH Life Sciences™, parent company of DLP. “In tandem with DPR, Dental Lab Products® places readers ahead of the curve with the highest quality coverage of new lab technology and product launches in the industry, aimed at improving day-to-day productivity and ultimately, the quality of patient care.”
Through various multimedia platforms, DLP provides industry professionals with balanced content, delivering in-depth coverage on a range of topics, including technology, equipment, materials, services and techniques with the goal of transforming dentistry and achieving success in the field.
“Innovations drive efficiencies as well as competitive pressures; therefore, it’s critical to stay up to date on the latest opportunities available to your dental laboratory,” said Noah Levine, editorial director for DLP. “Dental Lab Products® examines topics from all sides to create an unbiased product resource that keeps readers in the know regarding all facets of the industry.”

Coinciding with the revamp, DLP will regularly feature content about all aspects of the industry via article formats such as:

“Solve My Problem” — A showcase of novel approaches to lab tasks and workflows.
“Closer Look” — Firsthand product stories from technicians and lab owners.
“Technique”— Step-by-step workflows with detailed case images.
“Deep Dive” — Explanations of how and why products function as they do.
“Technical Remix” — Reviews of previously published techniques from lab technicians, with updates and tips using current technology, materials and workflows.

Dental Lab Products® (DLP) aims to provide dental professionals working in a laboratory setting with comprehensive information regarding emerging technology and innovation across the industry. A complementary resource to Dental Products Report®, DLP serves as the product-centered, techniques-based content provider steering lab businesses towards success. DLP® is a brand of MJH Life Sciences™, the largest privately held, independent, full-service medical media company in North America, dedicated to delivering trusted health care news across multiple channels.

Thursday, January 16, 2020

Phasor Composite Heater Continues to Impress


I’ve been a big of warming composites for a few years now.  Practicing in the Kansas City area, sometimes in the winter it gets downright *cold*.  On those days, when we would start our schedule, the office was still warming up a bit and the composite was still cool from the thermostat dropping the temp overnight.  To help make the composite easier to handle and more sculptable, I began to use a composite warmer.

That simple step quickly showed me that, no matter what the temp, warm composite is a dream to work with.  My only problem was that the moment the composite cartridge left the warmer, it began to cool a bit.  If only there was a way to keep it warm right up to the point of placing it into the preparation...

Enter Vista Dental’s Phasor.  I received a prototype device about 20 months ago (the device has been on the market a bit over a year) and I was hooked.  

As you can see from the picture above, the Phasor looks like a typical composite dispensing gun, but the similarities end there.  The Phasor has an LED array at the end of the barrel and this LED array emits infrared light that warms the composite right in the compule.  This also obviously keeps it warm right up to the point that it is delivered into the prep.

The device is powered by a rechargeable battery and heats the composite to three user selected temperatures.  The material is easy to express and a dream to work with in its softer state due to the warming.

It takes the device about 20 seconds to warm the material so I start the device in its warming cycle as I start the process of etching and applying the bonding agent.  That way by the time I’m ready to dispense, the Phasor is warmed up and ready to go.

This device has  proven to be hugely valuable to my clinical routine and is used on almost every restorative procedure I do.  The device is and continues to be *highly recommended*!!!

Wednesday, January 15, 2020

Ransomeware Hackers Now Threatening to Expose and/or Sell Patient Data


News is now starting to show up on the web that in addition to hackers encrypting drives in healthcare settings with ransomware, these same hackers are then threatening to expose PHI (Protected Health Information) on the Internet.  This double pronged attack is one more way that nefarious actors are using to try to force victims to pay the ransom.

This latest trick works like this:  Once hackers gain access to a system, they download a perfectly viable copy of the data and keep it.  Then they plant the ransomware which encrypts the victim’s hard drive.  In most instances when the hard drive is encrypted the computer screen shows a message that has the instructions for how to pay the ransom & often a countdown timer showing how much time remains before the data will be destroyed.

Now, in addition to that, the message also says that unless the ransom is paid all the downloaded data will either be made available on the web or sold to the highest bidder.  The victim is caught in a huge vice with this.  Not only do they need their data, but if it is released there is also the potential for huge fines due to HIPAA violations.

Even if an office has good restorable backups and can recreate their data easily, the fear of this PHI exposure may be more than enough to pay the ransom.

This whole data theft area is becoming dicer by the minute and is one more great reason to turn your network security over to professionals...

Tuesday, January 14, 2020

CEREC software wins Red Dot Design Award for outstanding user experience


The redesigned user interface of the CEREC software from Dentsply Sirona won a coveted Red Dot Award for Brands and Communication Design in November. The software is the centerpiece of CEREC, a leading CAD/CAM system that enables dentists to complete restorations ‒ from digital impressions to the finished crown ‒ in just a single session. The new digital user interface, enhanced help functions, and the intuitive Touch Pad make it easier to use than ever before.

Charlotte/Bensheim, 13 January, 2020. The "Rebrush CEREC Software" project from Dentsply Sirona and Ergosign was awarded a coveted Red Dot: Brands & Communication Design Award in the "Interface and User Experience Design" category in Berlin. From the 8,697 applicants, the jury chose the high design quality and intuitive user interface of this project.

Teams from Dentsply Sirona and Ergosign accepted the award at the awards ceremony. "This is recognition of the outstanding work and remarkable creativity that our teams have put into the development of CEREC", stressed Dr. Alexander Völcker, Group Vice President Digital & Orthodontics at Dentsply Sirona. "We are proud of having created a new software design with our colleagues at Ergosign that makes CEREC even easier, faster, and more intuitive to use than before. I warmly congratulate all involved in this success."

Just 5 clicks from the digital impression to the crown

The jury was especially impressed by the intuitive and visually appealing user interface and intelligent automation of the CEREC software. It allows dentists to design high-quality, esthetic crowns easily with just 5 clicks, produce them in one of the CEREC milling units, and insert them in the same session. After making the digital impression with the Primescan intraoral scanner, the preparation margin is then automatically marked, but can be modified manually at any time.

This, in addition to functional adjustments within the software and a changed biogeneric algorithm with improved consideration of the minimum material thickness, leads to initial proposals that require practically no modification. Numerous feedbacks and help functions shorten the learning curve and ensure that the CEREC software can be operated effectively from the start. Examples of the help functions are the color analysis function for support when selecting the suitable tooth color and the virtual articulator to determine functional contacts for improved static and dynamic occlusion.

The Red Dot Award: Brands & Communication Design 2019

The Red Dot Award is one of the largest design competitions in the world. The Brands & Communication Design award was initiated in 1993 as the "German prize for communication design". Since then, the award has been given every year to the world's best brand designs and most creative projects of designers, agencies, and companies in the categories "Brands" and "Communication". Around 1,400 international guests celebrated the winners at the Red Dot Gala on November 1 in the Konzerthaus Berlin. After the awards were presented, winners and guests had the opportunity to experience the winning projects up close at the Designer's Night in ‘ewerk’.

More information at

Monday, January 13, 2020

Lawsuit Alleges Juul may have Shipped 1 Million Contaminated Pods


Interesting info here and some terms via a quote that is NSFW, just so that you are aware...

The former CEO of Juul is alleged to have stated, "Half our customers are drunk and vaping like mo-fos, who the fuck is going to notice the quality of our pods.”

A lawsuit filed recently provides that quote and other info in an attempt to prove that Juul didn’t have much concern over the quality of their products or the health of their customer base.  The lawsuit was filed by Siddharth Breja, a former senior vice president of global finance for the company.  His employment was from May 2018 to March 2019.  The lawsuit also alleges that when he spoke out about the alleged contaminated pods, he was terminated.

The accusation is that Juul put over 1 million mint flavored pods into the market is early 2019 that were contaminated.  The lawsuit states that around 250k kits containing mint refills were contaminated but shipped to retailers who then sold them to consumers who used the affected pods in their Juul systems.

A company spokesperson stated “The allegations concerning safety issues with Juul products are equally meritless, and we already investigated the underlying manufacturing issue and determined the product met all applicable specifications.” 

This is one more piece of bad PR for the entire e-cigarette market.  The latest statistics that I’ve seen indicate 54 deaths related to vaping and 2506 cases of illness related to vaping.  The situation is serious enough that the CDC has created a name for the illness, now referring to it as EVALI (E-cigarette Vaping Associated Lung Inflammation).  The government is very involved in the situation with the CDC setting up an entire area of their website devoted to it.

With the current situation facing the industry, the last thing Juul needs is publicity dealing with a lack of quality control.  Of course, innocent until proven guilty, but nothing looks good for the e-cigarette market for the foreseeable future… not that we really need any nicotine delivery systems available.

Thursday, January 9, 2020

Dentistry Ranks as #2 in List of Top U.S. Jobs


I absolutely love the profession of dentistry and, from the looks of this survey, it seems that lots of other people love it too.

Every year US News & World Report puts together a very detailed list of the best jobs in the United States.  It’s broken down into several categories such as Healthcare, STEM, best paying, etc.  In the year just ended dentistry continued to hold a strong position.  It is #2 in the overall Best Job category and a whopping #1 in the Best Healthcare category.

As someone in the trenches who practices full time, I couldn’t agree more.  While there are a few days where working at a bait shop seems like a better idea than dentistry, those days are few and far between.  99% of the time I consider myself incredibly lucky to be able to earn a living doing what I truly love to do.  The profession allows you to call your own shots without having to (in most instances) dealing with the headaches that come with a job at a large corporation.  A large percentage of physicians now work for large corporations and while that allows doctors to focus more on patient care, there is also the other part that makes you just a gear in the machine.  Dentistry is not at that point with corporate healthcare… yet.  Most dentists make all of their own decisions without the trouble that comes with corporate overseers.

Dentistry is a terrific profession.  It allows you to help people in ways that they understand & appreciate while also getting to know those people very, very well.  Not many of us enjoy being patients, but people are very good at understanding we are there to help them and to make the experience as pleasant as we are able to do.

I routinely tell my younger patients who are starting to look at their career path, “Figure out what you love and do that.”  Money is important, but it doesn’t mean all that much if you are miserable.  

Dentistry is a tremendous career… if you LOVE it.  However, if everyday when you look in the mirror you are miserable, you should immediately begin to work on finding what you love and working toward *that*.  

Tuesday, January 7, 2020

SureSmile learning app honored with AXIS Award for Learning Technology


Dentsply Sirona’s SureSmile education team received this year’s prestigious AXIS Award in the category Learning Technology. With this award, the Association for Talent Development (ATD) Dallas recognizes organizations for outstanding engagement in workplace learning and talent development. The SureSmile education team received the award for the innovative learning application SureSmileU. This app supports SureSmile users around the world by providing on-demand learning content in multiple languages tailored to their individual learning needs.

Charlotte, January 7th, 2020. Dentsply Sirona’s SureSmile education team, led by Program Manager Amanda Ballard, was honored with the 1st place AXIS Award in the Learning Technology category at the 5th annual ATD Dallas AXIS Gala.
“Our aim is to train our orthodontic clients and our employees to perform their best in very complex work environments with sophisticated, ever-changing products,” said Amanda Ballard. “To support this critical need, we’ve conceptualized SureSmileU, an app that provides on-demand learning for our digital orthodontic solution and that helps our employees to provide efficient customer support at the highest standard.”

To improve the learning experience for users and employees alike, SureSmileU features artificial intelligence allowing the content to adapt flexibly to individual learners’ needs. In addition, the app is mobile optimized, and desktop enabled, allowing the user to choose and switch between learning devices.

“As the global leader in the dental industry, Dentsply Sirona has a strong focus on clinical education and client support,” said Terri Dolan, Chief Clinical Officer at Dentsply Sirona. “We are very proud of the outstanding and creative work our SureSmile education team put into conceptualizing the SureSmileU app. Congratulations to all of you for making the app a great success.”

Since the launch of the app, Dentsply Sirona has seen accelerated growth in the number of users and adoption among both internal and external customers and a 500% increase in course completions for online training.

SureSmile - the full-service clear aligner solution for orthodontic treatments

SureSmile is Dentsply Sirona’s digital solution for orthodontic treatment with clear aligners. It features a robust case planning tool that enables orthodontists and technicians to simulate treatments and find the ideal aligner designs for each case. Once the design is complete, the aligners are then produced in Dallas, Texas, using a combination of 3D printed models and robotic laser trimming – resulting in aligners with exceptional fit and function.

Monday, January 6, 2020

Starting Off the New Year with the Pursuit of Perfection...


Happy New Year everyone!  Over the holiday season here in the U.S. I always try to take some time off from patient care and also to step away from online duties for a bit in order to rest up and recharge the creative part of my brain for the new year ahead.  Now I’m officially back and ready to hit the ground running.

Let’s start out the new year with my most recent article that appeared in my Technology Evangelist column in Dental Products Report.  We are all geared for perfection, to be the best we can be and to provide the best care we can for our patients.  This care extends not only to the brains & hands that deliver it, but to the products used to create our restorations.  To put it bluntly, if you want to BE the best you need to USE the best.  So give this article a read.  Hopefully it will help you think about your current situation and possibly what you can do to improve.

If you are interested in other articles I've written over the years, you can find them at DPR's Technology Evangelist Resource Center.

As Technology Evangelist, I have worked hard over the years to bring you all as much information as I can about new devices, materials, and techniques. This year I will continue to do that, but I’ve decided to also occasionally discuss some topics I think will flat out improve our profession as well as the care we provide our patients.

This month let’s take a look at one of the most common product categories in our profession and how that category impacts a concept that is beaten into us from the first day we set foot into a dental institute of higher learning.

What does it mean to “focus on perfection?” I once heard the following joke and I thought it would be a great demonstration of what I’ll be discussing this month.

There was a college class full of a mix of engineering students and math students. It was being taught by Bob a mathematics professor. One day a friend, Sam, who happened to be an engineering professor approached him.

“Hey,” he said, “I bet I can tell which of your students are math majors and which are engineering by a simple test.”  They agreed to try the experiment the next day.

That day, Sam got in front of the class and asked everyone to stand up and follow him to the parking lot where he lined them up in front of a brand-new Ferrari. “We are going to do an exercise,” he stated. “This is how it will work.”

First, he had all the students line up along the wall of the building facing the parking lot.
Sam then instructed, “Each time I tell you, each of you can cover half the distance to the Ferrari in front of us. The first one to reach it can have it.”

Immediately all of the mathematics majors turned around and walked back inside the classroom. Sam than confidently said, “Here are the engineering students.”

The joke, of course, is that the math students had all quickly figured out that no matter how long they played the game, they would never reach the car because they can only get halfway there. Each time those halves grow smaller, but they never go away.

However, all the engineering students remained standing because they had reasoned that even if they could never actually reach the goal, they could get close enough to accomplish what they hoped to accomplish.

While this joke perhaps generalizes too much, it does speak volumes about what our goals should be.
In our training, we are constantly reminded that our goal is “perfection”.  I put it in quotes there because, like the mathematics students, we all know that perfection is unattainable.  Given the environment that we practice in, sometimes “clinically acceptable” can be a challenge. Yet, I think those who train us focus us on perfection for a very good reason.  That reason is: If you are striving for perfection and can sometimes only achieve “acceptable” what would the result be if we started out with “acceptable” as the final goal?

Perfection is incredibly difficult or impossible to attain, but does that mean we should cease striving for it?

As Technology Editor for Dental Products Report I get some really incredible opportunities to learn about what we do.  Recently I had the opportunity to do some work with bonding agents in a laboratory setting. The exercise was to use a standardized industry-wide testing protocol to see just how strong our bonds to tooth structure truly are.

One of the many great things about doing your very own experiments in the lab is that it gives you the opportunity to actually put things in context so that you actually understand them on a personal level.  Often manufacturers and their sales reps will share data with us in the forms of charts & graphs. The problem for us doctors is that if we cannot translate what they show us into a form we understand they might as well be speaking a foreign language (and for me maybe more so than others).

So, to start this conversation let me give you some context.  One of our most common procedures is “bread & butter” operative dentistry.  We all place fillings every day and the success of these restorations is very important to our patients.

If our restorations fail quickly, our patients lives and health is affected negatively.  That’s why aiming for perfection is so darn important! Yet I think many of us struggle to define just what we are striving for when we strive for perfection.

I would argue that the best way to aim for this is to aim to put the tooth back into as close a state of physical strength as possible.  Shade, anatomy, and other things are also important, but if out target cannot survive the physical and mechanical environment it exists in, then failure is a result not far over the horizon.

So, my goal is for the tooth to be as strong as it was before it was weakened.  To that end it would be helpful to know just how strong the tooth is in the first place.  Utilizing the same fracture resistance testing used to fracture restorative materials, I fractured healthy tooth structure.  It turns out that under this testing protocol, healthy teeth fracture at between 80-90mPa (megapascal). The specimens tested all fractured within that range.

Given that range we now know how strong the tooth is.  That piece of knowledge now equips us to understand what the “perfection” is we are aiming for.  In order to put the tooth back into a state to withstand its environmental demands our goal is 80-90mPa.

The frightening piece of information that I personally learned in the lab is that practically all bonding agents currently on the market are falling FAR short of that number even when being used strictly according to the manufacturers instructions as well as being performed under ideal conditions. 

So the logical question to be asked is if before starting a procedure a doctor knows his/her material will provide an inferior result, why should that material be used?  When our mission is to “strive for perfection” why would we begin with building blocks that are not the best available to us?

Interestingly enough, there were several of us working in the lab that day and we compared our results.  We each followed the instructions “to a *T*”. We were careful, we were patient, and we each got similar results.

The intriguing and somewhat frightening information I learned is that there are some very popular bonding agents on the market that provide very poor clinical results. Knowing that the tooth is 80-90mPa would you want a restoration in your own mouth that has a bond strength of <30mPa?  Personally I would not, and there were some materials that! No matter the tester, never exceeded 30.

I think the pursuit of perfection here demands that we, as doctors, ask our manufacturers for data and then make the effort to understand it as best we can. That isn’t always easy and it may sometimes require asking for help, but that’s ok.  Asking is how we learn and it’s a much better way to learn than making mistakes and learning from them.

I think it is also important that we demand from manufacturers that they use standardized testing protocols, not just ones that make their products appear superior.

Also a focus on cost should not be the principle decision making matrix in your practice.  A doctor HAS to pay the bills or they will not be able to help anyone, but a focus on costs is not the recipe for clinical success. 

To use bonding agents as a sample here, I’ve had colleagues say “Why should I pay $1.75 per use when I can pay $1.00?”

My reply is because using inferior products leads to inferior restorations & what does it cost in hard costs & reputation to redo restorations?

Clinical success leads to referrals.  I’d much rather experience *that* kind of success than to save 25 cents per filling.

I *love* science and I also *love* the science of dentistry.  This experience has had such a profound impact on me that I am setting up a testing facility in my office so that I can become able to do all of this testing with my own hands.  I feel having this unbiased information in my hands is that critical.

I know most of you do not have the space or the time to do these kinds of things for yourself, but the good news is I will be gladly sharing some of this info here in the pages of Dental Products Report.  That way we are not limited in the sources of our information.

In closing, we all know that perfection is unattainable, however we owe it to our patients to aim for it every single day.  They deserve nothing but our very best and I will do my very best to provide you with the information you need to perform at your very best for them.

It’s going to be a lot of fun around here in 2020.  I hope you enjoy the ride. And me? I’ve never been more excited to be your Technology Evangelist.  Now let’s go places together!

Wednesday, January 1, 2020

Taking Time Off for the Holidays...

Posts will resume on Monday January 6th.


I’m taking a couple weeks off to rest and recharge.  Don’t worry… I’ll be back!