Thursday, July 29, 2021

Experience with iTero Element 5D Plus


As promised yesterday, here is a fairly long post about my experiences with the newest scanner from iTero.  Hopefully this provides some of you with the insight into the product that you need to make a decision of whether it is right for your practice or not...

I still remember it like it was yesterday, only it was fifteen years ago… fifteen years! I was walking the exhibit floor of the American Dental Association meeting in Las Vegas when I came across a very small booth with a very intriguing device. The company was Cadent and the device was named iTero.

It was a digital impression system, but unlike the other systems at the time, it didn’t also come with a mill.  The unit acquired a digital  impression and then, using WiFi, sent the data to a Cadent milling facility where huge mills turned all of those 1s and 0s into an actual hard plastic model and then sent the model to the doctor’s lab.

As a tech lover I was intrigued.  At long last there was a company for all the doctors that wanted the advantages of digital impressions but didn’t want to buy or use a mill.  I began to do my research and before long, I owned a unit. My staff was thrilled and once we implemented our iTero into our workflow, we never looked back.

A few years later, we upgraded by purchasing the then state of the art iTero Element unit.  The staff and I were thrilled with the improvements to both the hardware and the software of the system. I had originally planned on having the staff use both of my iTero units, but the Element was so much faster and easier, that our first unit quickly began gathering dust as the Element took over.

So after all of this time using their products, I was more than thrilled when the company reached out to Dental Products Report and myself with the idea of letting me do a Test Drive on their latest and greatest unit, the iTero Element 5D Plus.

First Look

I love watching devices evolve and the Element line is no exception.  The unit has taken the advantages of the original Element unit and improved upon them.  The stand is more stable and more aesthetic.  The wheelbase has been expanded a bit and the length of the wheel arms extended slightly which greatly increases stability.  The unit has also been given some light and dark accents that give it much more of a ‘space age’ look.

The unit was shipped to us disassembled and my trusty assistant and ‘fix-it gal’ Nicky had it assembled and ready to roll in less than a lunch break.  When she first turned the unit on we were asked to connect to our secure WiFi and then to input our account information.  Being existing iTero customers, we put in our customer information and within moments all of our previous cases and settings were downloaded from The Cloud and we were ready to roll.  It was easy and impressive.  

In the Clinic

In order to better keep track of how the Element 5D Plus performed, I decided that for the length of our Test Drive we would use ONLY the Element 5D. Plus.  So we took our beloved Element and mothballed it until the Test Drive was over.

Our office is a three doctor practice and all clinical personnel are trained on using our iTero.  So needless to say, there was a bit of jockeying to see who got to use the Element 5D Plus first.  I think that alone says something about the unit.  We already had a unit everyone was familiar with but everyone wanted a turn with the new one.  I’m pretty sure that Nicky pulled the trump card of “Hey, I assembled this unit” because she got the first case.

We were both blown away.  The screen resolution is *stunning*.  Details are easily and clearly identified and the scans are gorgeous.  The processing power is also downright impressive.  We always position the iTero so that the patient can easily see the monitor while the scan is taking place and the speed with which the data appears on the screen is phenomenal.  When I started with digital impressions in the late 90s the operator was actually taking photos with the device by tapping a foot pedal and then when enough still images had been acquired, the system’s software would assemble those still images into a 3D digital representation.

Watching the iTero Elements 5D Plus scan the mouth is akin to watching water flow over an object.  The system takes thousands of images per second and combined with the processing power of the device, the scan appears smoothly and precisely.  Patients are practically hypnotized by the experience.  The color depth allows for easy margin discernment and the resolution allows the user to enlarge the image on the screen with no loss of detail.

One other clinical feature bears mentioning.  I love efficiency and the time savings it brings.  In the past when moving our iTero from operatory to operatory, it was necessary to power the unit down, wheel it in, plug it in, and then go through the boot sequence.  While it wasn’t a tremendous weakness, it did impede clinical progress on many occasions.  Being a three doctor practice there are times when the scanner is in use by another clinical team while the second team waits for the unit.  The power down and power up steps simply added time to the process.  Now that problem is history.  The Elements 5D Plus comes with a built-in battery.  That means when one team is done, the unit can be unplugged and moved to where it is needed next without fussing with the ‘power problem’.  Now the unit is wheeled in, plugged in, and working on the next case in a matter of seconds.  This has saved time and, more importantly, frustration for clinical personnel.


The clinical results have been phenomenal.  The cases we have performed with the help of the Elements 5D Plus have been accurate and the prosthetics require minimal chair time to seat.  One of the best things about iTero scans is the time they save both on the front end and the back end.  The system is fast and accurate on the front end and this leads to incredible accuracy on the back end.  In the old days of analogue impressions when a case went to place with no adjustments it was a high-five moment.  Now when adjustments are necessary we evaluate what happened on the front end to make that happen.  Our expectations are now that cases fit with minimal to NO adjustments.

It’s also a tremendous advantage of the system that our lab receives the case within minutes.  We can discuss the case with the lab if need be almost as soon as it is done.  It also means for cases that are done model-less, the lab can begin to design the case practically before the patient has left our office.

The scans have also been used to create restorations with our Axsys 5x 400 mill.  Obviously having a mill is not a requirement to have the iTero experience in your office, but if you do own a mill or are considering purchasing one, your iTero scanner will provide incredibly accurate data for your design process.

Additional Applications

The Elements 5D Plus is a terrific intraoral scanner, but it does more… much more.  In addition to scanning cases for fixed prosthetics, the device has several other uses.

Intraoral Camera

In addition to scanning, the system can also take beautiful intraoral images.  This is a nice time saver/efficiency booster for documenting things.  Need to have photos of your preparation to send to third party payers?  No need to stop and pick up your operatory intraoral camera.  You can take those photos directly with the iTero.


I think all of us have probably had the experience of saying to a patient something along the lines of, “Your teeth are showing signs of excessive wear.”   Only to be met by the response, ‘No they aren’t.”  Or, “It looks like you are grinding your teeth.” And we hear, “No I’m not.”

My undergrad Psychology degree has always wondered why so many people have a hard time admitting to bruxism, but they sure do.  I tend to think it’s because they don’t realize they are doing it, combined with the fact that they cannot see it either.  These situations are much easier to deal with due to one of the great iTero features, the Occlusogram.  Now rather than *telling* a patient they brux, within a few seconds you can *show* them.  In my office we prefer to scan and discuss what we see before we even mention the problem verbally.  This makes the acceptance of the situation much easier.

Humans are visual creatures.  Over 85% of what we discern about our environment comes through our eyes.  The Occlusogram plays to that advantage.  It shows the teeth with a color ‘weather radar’ appearance that clearly identifies the patients wear patterns.  It is a tremendous educational tool and is a great adjunct to our office philosophy of Focus, Educate, Relationships.


Have you ever monitored a patient for several years and at an exam you really wish you could show them how the condition of their dentition has changed over the last few years?  This magic is now at your fingertips.  iTero’s TimeLapse feature does just that.  If you scan a patient multiple  times over the span of their time in your office, the Elements 5D Plus can combine those scans and create a video that shows the changes that have occurred right before the patient’s eyes.  

This is a powerful tool that can provide, literally, years of data in the span of a few seconds and greatly increases patient understanding.  Because the Elements 5D Plus scans so quickly and is so easy to use, we have incorporated scanning every new patient to the practice.  This is helping us to build a baseline of patient data.  Our goal is to incorporate a digital scan into our normal six month hygiene visits.  This will allow us to easily and efficiently monitor every patient.

Near Infrared Imaging

Another benefit built into the Elements 5D Plus is the implementation of Near Infrared Imaging.  NIR (pronounced NEAR) in science circles, is a tremendous addition to the digital scans acquired by the system.  

The infrared spectrum is outside of the visual spectrum so the energy is invisible to the human eye, but this harmless wavelength easily penetrates tooth structure.  This allows the Elements 5D Plus to also operate as an incredibly accurate and powerful transillumination device.  As the operator moves the wand around the teeth, the NIR energy is passed through the tooth and picked up by the camera.  After completing the scan, the operator can tap an icon on the screen and see the scan through the eyes of NIR imaging.

Viewing the dentition through NIR is one more data gathering tool for the doctor to help render a clinical decision.  Combining things such as NIR with the data acquired through digital radiographs can add accuracy to a clinical situation that might have been difficult to create a diagnosis with a high degree of certainty without these extra data points.  NIR is also non-ionizing meaning that it can be used on pregnant patients and young children without any concern regarding radiation.

Whether used as a diagnostic scan in hygiene or reviewing scans taken for routine prosthetic cases, NIR is a feature that is accurate, always on, and simple to use.  During our Test Drive I encountered several areas of decay that I would otherwise have not identified.


Acceptance of digital scanners is continuing to increase in the profession; now at a bit over 30%.  The current generation of systems are highly accurate and easy to use.  I no longer hear questions about their ability to capture correctly or the fit of prosthetics made from digital scans.  My office is now to the point of taking an analogue impression for fixed prosthetics about twice a year or one every six months.  

A full mouth scan takes approximately 5 minutes.  For a team member that has never used a scanner previously it might take a bit longer at first, but the learning curve is ridiculously short.  Even our study models are now done digitally and the models created using our 3D printer.  Gone are the days where study models were taken in alginate and then poured immediately to minimize distortion.  Cases are stored in The Cloud and can be reprinted easily if the need arises.

Also as I mentioned previously, the seating of cases is tremendously easier than before.  Single unit cases (which are the majority of cases seated in the average general dental practice) are frequently accomplished in 10 minutes.  We normally block 30 minutes for a single unit seat, but it is now a rare occasion when it takes longer than 10 minutes.  

While I’m at it, allow me to let you in on a secret… patients *hate* impressions.  They are fascinated and impressed with the Elements 5D Plus and they talk about it to their friends and relatives.  One of the unseen benefits of the system is that the technology markets itself.  We get referrals based on digital impressions and our overall use of technology to improve patient outcomes.

Wrapping Up

I’ve been an iTero client for well over a decade… for good reasons.  However, I’m not just impressed with the Elements 5D Plus simply because of that fact.  No, I’m impressed because the system does so darn many things!  I also feel that as a long term client I have a better appreciation for how much their systems have improved.

Caries detection, occlusal analysis, time lapse videos, intraoral photography, and digital impressions are all wrapped up in a highly aesthetic and highly mobile high tech package.  I know a lot of you that have not yet made the jump to digital are weighing your options.  The lack of trade shows for over a year hasn’t helped.  However, if you are looking to make a purchase in the not too distant future and you saw an iTero unit a few years ago, you owe it to yourself to take a close look at the Elements 5D. Plus  

Suffice it to say if you haven’t seen iTero haven’t seen iTero.

Oh… one other detail I should tell you.  There is a time limit to my Test Drives and there always comes that point in the process when the product has to be sent back to the company that was gracious enough to allow me to have time to evaluate it.

This time was a bit different.  I was so impressed with the Elements 5D Plus that I called the company and had them start the paperwork so that I could have one of my very own.  In just a couple of months the technology had become indispensable to my team and I.  The Elements 5D Plus is an impressive device.  I’m so impressed that I cannot do without it.  I think you will feel the same way.

Wednesday, July 28, 2021

iTero Element 5D Plus Test Drive


The world of digital impressions continues to expand.  Market penetration is getting higher, with well over 18% of offices now embracing the technology. 

We started the process of doing digital impressions in the fall of 2008.  At that time I purchased the original Cadent iTero.  At that point in the curve, there were not too many devices that allowed you to send cases to a lab for fabrication.  Back then it was more of in office CAD/CAM systems.

Times have changed a lot in the last 13 years.  We recently have been working with the latest device from iTero, the Element 5D Plus.  The company reached out in the early spring to see if I would be interested in putting their latest scanner through its paces in my office and, of course, I said yes.

Tomorrow I'll be posting about the experience and what I think of the unit.  This is the fourth iTero device I've worked with in my career.  I started out with the original, then I worked with the company during the beta of generation 2.  I purchased the original iTero Element (which was the first tablet style device) and now the Element 5D Plus.  I feel like having experience with so many models has given me a decent depth of experience to draw from as I check out the changes and improvements. 

I'll give my final report tomorrow.

Monday, July 26, 2021

My Experiences with AMD's New Monet Handheld Curing Laser

Curing is an interesting subject. In some ways, in its history curing has changed a lot… and in some ways it's changed very little. Let me give you an example of what I mean.

In the early days of light curing we used actual light bulbs to produce enough of the proper wavelength of light needed for polymerization.   These were replaced by “high speed curing lights” that used powerful halogen bulbs to create stronger beams with greater curing potential.  However, even though they were more powerful, halogen bulbs still required long curing times.  Back then 40-60 seconds per increment was not unheard of.  That’s because those light bulbs put out all kinds of different wavelengths of light and it took time for enough of them to cause photopolymerization.  It was akin to throwing spaghetti against the wall and hoping enough would stick.  

The industry’s ‘Holy Grail’ became the sub thirty second cure.  Companies tried tips that better focused the energy (called Turbo Tips) and there was even a type of light referred to as a PAC Light which stood for Plasma Arc Curing that could give a fast cure, but they were expensive and bulky.

Then in 2000-2001 the LED curing light took the market by storm.  Suddenly dental curing lights were powerful and small.  Within five years, curing lights using bulbs were practically off the market; replaced by smaller and more reliable LED systems that provided amazing results in adhesive dentistry.

Here’s a little bit of dental trivia that you probably don’t know.  Every time you use a LED curing light, you should thank its inventor, Densen Cao, PhD.  He’s the man who invented this amazing device.  Now why would I mention Dr. Cao in a discussion of a new curing light?  It’s because he is also the inventor of the handheld curing laser.

And who better to stand the world of curing lights on its collective head than the man who has already done it once?  Welcome to another game changing piece of hardware from the fertile mind of Densen Cao.

Over the past twenty years we have seen tremendous strides made in our curing lights.  Intensity has increased and power needs have decreased.  Today lights can cure an increment in 5 seconds and are cordless, going days without needing a charge.  So where do we go from here?

The next generational jump in curing is the Monet curing laser.  There has never before been a curing laser that fits in the palm of your hand.  The Monet takes over with properties only a laser can bring… the most important being collimation.  

With any light other than a laser, photons spread out in all directions as they leave the source.  However with a laser they all move in a tight beam that basically forms a column of photons (hence the term collimation) .  This means that every photon produced strikes the target.  Why is this important?  It gives the laser more power and greater depth of cure.  Simply put, there is very little waste of curing energy from a laser.

There is also a terrific advantage to laser cured restorations.  With “normal” curing lights it is imperative to be as close to the restoration as possible. If an LED light moves even 2 or 3mm away from the restoration, the amount of curing power that the light delivers decreases exponentially.  Lasers, due to their collimation, can properly cure a composite even if it is several millimeters from the target.  This means that you get a properly cured restoration every time.  

I’ve spent a lot of time in dental offices in my career and there is one mistake that I’ve noticed time and again.  An assistant puts the curing light close to the target and then looks away, in an effort to protect their eyes.  However the simple act of looking away often means the light moves away from the target and the LED beam intensity drops.  The material cures on the surface, but doesn’t receive sufficient depth of cure.  The result is what i call “candy composites” which are “crunchy on the outside and chewy on the inside”.  This creates all kinds of problems later, as we all know.  That same situation would never happen with the Monet as the beam intensity is sufficient for a properly cured composite even if the device isn’t next to the target.

The collimation also means better depth of cure.  When using a laser, every photon that is produced hits the target.  This creates an incredibly strong restoration because the strength of the beam penetrates deep into the material.  AMD’s in-house measurements have found a depth of cure of up to 8mm.  Think about that for a moment.  Now, for argument's sake let’s say that number is actually 6mm.  Given the stat that over 80% of class 2 restorations are 5mm or less, that means the Monet has just changed 80% of your restorations to bulk fill even if the material is not designed to be bulk fill.  And that means your efficiency just took a really big boost.

It has always been popular for a curing device to have a variety of settings for intensity and time.  The Monet completely changes that concept.  It has one button that produces one three second curing cycle.  That’s all there is because that is all you need. 

The curing head can rotate 360 degrees so the user can position it with ease.  It also comes with 2 interchangeable batteries to insure the Monet is always ready.  The device also comes with laser protective eye glasses which should always be worn when using the device.  Lasers have a strong beam and eye protection is a must when using one.

The Monet provides intensity that makes composites stronger, increases efficiency, and is competitively priced.

If you are in the market for a curing light, you owe it to your patients to check out the Monet.  It will take your curing to a whole new level!

Disclaimer:  I received a very early prototype of the Monet that gave me the opportunity to work with it before it was available for sale.  This spring after the product launch, AMD Lasers asked Dental Products Report if I would do a "Product Test Drive" on the Monet.  This article is part of that project and I was compensated for the work involved with that product evaluation.

Thursday, July 22, 2021

FDA Looking at Early to MidWinter Rollout of COVID-19 Vaccine for Six to Twelve Year Olds


Good news for parents with younger children.  The Food and Drug Administration (FDA) has stated that an Emergency Use Authorization (EUA) for a Covid-19 vaccine safe to administer to children  under 12 may be available midwinter of 2021-2022.

As you might know, the current recommendations are for children 12 and over.  That leaves younger children reliant on masks for safety and if you are a paren't, you know how easy it is to get a youngster to keep a mask on.

So this is great news for parents with kids in that age group.  Of course, the medication will still be under EUA, which might give some parents pause, but I would rather have my child vaccinated than risk them becoming infected with Covid-19.

Another thing to note, which is a good thing for parents, is that the FDA is going to have 4 to 6 months of follow up data prior to allowing the use on children under 12.  When the testing was being done for the 12 and over group the FDA only required 2 months of data.  While not an extremely long time, that is still two to three times longer than for adults, which I think is wise.

The EUA won't last forever either.  At some point the vaccination will gain full approval.

Here is the press release from the FDA regarding the clearance for 12 to 15 years of age.  I think this info gives a lot of info that shows the caution they are taking with this and this should apply to the next cleared age groups as well.  This was released on May 10th.

Today, the U.S. Food and Drug Administration expanded the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to include adolescents 12 through 15 years of age. The FDA amended the EUA originally issued on Dec. 11, 2020 for administration in individuals 16 years of age and older.

“The FDA’s expansion of the emergency use authorization for the Pfizer-BioNTech COVID-19 Vaccine to include adolescents 12 through 15 years of age is a significant step in the fight against the COVID-19 pandemic,” said Acting FDA Commissioner Janet Woodcock, M.D. “Today’s action allows for a younger population to be protected from COVID-19, bringing us closer to returning to a sense of normalcy and to ending the pandemic. Parents and guardians can rest assured that the agency undertook a rigorous and thorough review of all available data, as we have with all of our COVID-19 vaccine emergency use authorizations.”

From March 1, 2020 through April 30, 2021, approximately 1.5 million COVID-19 cases in individuals 11 to 17 years of age have been reported to the Centers for Disease Control and Prevention (CDC). Children and adolescents generally have a milder COVID-19 disease course as compared to adults. The Pfizer-BioNTech COVID-19 Vaccine is administered as a series of two doses, three weeks apart, the same dosage and dosing regimen for 16 years of age and older.

The FDA has determined that Pfizer-BioNTech COVID-19 Vaccine has met the statutory criteria to amend the EUA, and that the known and potential benefits of this vaccine in individuals 12 years of age and older outweigh the known and potential risks, supporting the vaccine’s use in this population. 

“Having a vaccine authorized for a younger population is a critical step in continuing to lessen the immense public health burden caused by the COVID-19 pandemic,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “With science guiding our evaluation and decision-making process, the FDA can assure the public and medical community that the available data meet our rigorous standards to support the emergency use of this vaccine in the adolescent population 12 years of age and older.”

The FDA has updated the Fact Sheets for Healthcare Providers Administering the Vaccine (Vaccination Providers) and for Recipients and Caregivers with information to reflect the use of the vaccine in the adolescent population, including the benefits and risks of the Pfizer-BioNTech COVID-19 Vaccine.

The EUA amendment for the Pfizer-BioNTech COVID-19 Vaccine was issued to Pfizer Inc. The issuance of an EUA is not an FDA approval (licensure) of a vaccine. The EUA will be effective until the declaration that circumstances exist justifying the authorization of the emergency use of drugs and biologics for prevention and treatment of COVID-19 is terminated, and may be revised or revoked if it is determined the EUA no longer meets the statutory criteria for issuance or to protect public health or safety.

FDA Evaluation of Available Safety Data

The available safety data to support the EUA in adolescents down to 12 years of age, include 2,260 participants ages 12 through 15 years old enrolled in an ongoing randomized, placebo-controlled clinical trial in the United States. Of these, 1,131 adolescent participants received the vaccine and 1,129 received a saline placebo. More than half of the participants were followed for safety for at least two months following the second dose.

The most commonly reported side effects in the adolescent clinical trial participants, which typically lasted 1-3 days, were pain at the injection site, tiredness, headache, chills, muscle pain, fever and joint pain. With the exception of pain at the injection site, more adolescents reported these side effects after the second dose than after the first dose, so it is important for vaccination providers and recipients to expect that there may be some side effects after either dose, but even more so after the second dose. The side effects in adolescents were consistent with those reported in clinical trial participants 16 years of age and older. It is important to note that as a general matter, while some individuals experience side effects following any vaccination, not every individual’s experience will be the same and some people may not experience side effects.

The Pfizer-BioNTech COVID-19 Vaccine should not be given to anyone with a known history of a severe allergic reaction, including anaphylaxis—to any component of the vaccine. Since its authorization for emergency use, rare severe allergic reactions, including anaphylaxis, have been reported following administration of the Pfizer-BioNTech COVID-19 Vaccine in some recipients.

FDA Evaluation of Available Effectiveness Data

The effectiveness data to support the EUA in adolescents down to 12 years of age is based on immunogenicity and an analysis of COVID-19 cases. The immune response to the vaccine in 190 participants, 12 through 15 years of age, was compared to the immune response of 170 participants, 16 through 25 years of age. In this analysis, the immune response of adolescents was non-inferior to (at least as good as) the immune response of the older participants. An analysis of cases of COVID-19 occurring among participants, 12 through 15 years of age, seven days after the second dose was also conducted. In this analysis, among participants without evidence of prior infection with SARS-CoV-2, no cases of COVID-19 occurred among 1,005 vaccine recipients and 16 cases of COVID-19 occurred among 978 placebo recipients; the vaccine was 100% effective in preventing COVID-19. At this time, there are limited data to address whether the vaccine can prevent transmission of the virus from person to person. In addition, at this time, data are not available to determine how long the vaccine will provide protection.

Ongoing Safety Monitoring

As part of the original EUA request, Pfizer Inc. submitted a plan to continue monitoring the safety of the vaccine as it is used under EUA. This plan has been updated to include the newly authorized adolescent population, and includes longer-term safety follow-up for participants enrolled in ongoing clinical trials, as well as other activities aimed at monitoring the safety of the Pfizer-BioNTech COVID-19 vaccine and ensuring that any safety concerns are identified and evaluated in a timely manner.

It is mandatory for Pfizer Inc. and vaccination providers to report the following to the Vaccine Adverse Event Reporting System for Pfizer-BioNTech COVID-19 Vaccine: all vaccine administration errors, serious adverse events, cases of Multisystem Inflammatory Syndrome and cases of COVID-19 that result in hospitalization or death.

Wednesday, July 21, 2021

Cellerant Consulting Announces Best of Class Hygiene Awards



Cellerant Best of Class Hygiene Award Program Launches for 2021

Washington, DC; July 21, 2021 – Cellerant Consulting Group is excited to announce the launch of the inaugural Cellerant Best of Class Hygiene Award Program. “Since 2009, the Cellerant Best of Class Technology Awards have identified and acknowledged the top technologies in dentistry,” said Melissa Turner, Chief Hygiene Officer at Cellerant. “We will now expand the program to focus on the dental hygiene community as well.”

“We recognize the importance of this critical and respected community,” said Dr. Lou Shuman, CEO of Cellerant and founder of the Best of Class Technology Awards. “Since first adding a hygiene division to Cellerant Consulting two years ago, the interest in dental hygiene products, services and brands has exploded, with much growth anticipated in the future. We’re proud to have brought together an expert selection panel of dental hygienists recognized as industry leaders from across the country.”

About The Cellerant Best of Class Hygiene Award

The Cellerant Best of Class Hygiene Award selection panel consists of 9 renowned thought leaders and educators who, over the course of each year, will seek out and conduct research on potentially practice-changing technologies, with deliberations on nominees and final voting taking place in February. Panelists are precluded from voting in any category where they have consulting relationships. The entire selection process is conducted and managed on a not-for-profit basis. This year’s winners will be announced in December 2021.

The Cellerant Best of Class Hygiene panel members include:

Melissa Turner, BASDH, RDHEP, EFDA- Chief Hygiene Officer, Cellerant Consulting; Editorial Advisory Board, RDH Magazine; Co-founder, National Mobile & Teledentistry Conference; Co-Founder, The Denobi Awards; Founder- I Heart Dentistry Network; Co-host, Dentistry Gone Wild; Co-creator, Oral Health United

Pamela Maragliano-Munez, RDH, DMD, FACP- Chief Development Officer, Cellerant Consulting; Editor In Chief, Dental Economics; Editorial Director, Dental Academy of Continuing Education; Associate clinical professor, Tufts University School of Dental Medicine

Andrew Johnston, RDH, BSBM- Director of Hygiene, Coast Dental; Co-host, A Tale of Two Hygienists

Amanda Hill, RDH, BSDH- Host, Your Dental Top 5; Editorial Advisory Board, RDH Magazine; Industry Educator, Dental Post; Certified Educator, OSAP-DALE Foundation

Brooke Crouch, RDH- Vice President, American Mobile & Teledentistry Alliance; Clinical Advisory Board Chair, Virginia Health Catalyst; Oral Health Action Team Chair, United Way of Roanoke Valley 

Kristin Goodfellow, RDH, BA- Clinical Director, OraCare Oral Rinse; 2013 Recipient, Proctor & Gamble’s Excellence in Patient Communication Award; Featured author, Dental Products Report & RDH Magazine

Michelle Strange, MSDH, RDH- Co-host, A Tale of Two Hygienists; Client Success Manager, MouthWatch; Co-founder, LevelUp Infection Prevention; Editorial Advisory Board, Dental Economics

Nancy Miller, RDH, BA- Founder, UltraConcepts; Clinical Advisor, Jameson Management; Adjunct Faculty & Clinical Instructor, Northeast Wisconsin Technical College;  

Sarah Crow, RDH- President-elect, ADHA Massachusetts; Co-founder MDHA Mentor Liaison Team; Recipient, Massachusetts Dental Society Hygienist of the Year; Recipient, Middlesex Community College Member of the Year; Feature Writer, ADHA Access Magazine

For more information on the Cellerant Best of Class Awards and winners, visit

About Cellerant Consulting Group

Founded and led by CEO Dr. Lou Shuman, DMD, CAGS, Cellerant is the leading dental incubator and accelerator currently servicing 42 dental companies. Cellerant provides strategic dental market insights, clinical expertise, implementation resources and support to accelerate growth for client dental companies. Cellerant services include new concept incubation, clinical product evaluation, product development, continuing education program development and CE sponsorship, strategic branding and marketing, online marketing, lead generation and dental media relations management. 

Press Contact

Melissa Turner, Chief Hygiene Officer, Cellerant Consulting Group

Tuesday, July 20, 2021

Pegasus Malware from NSO Group Used to Target Human Rights Activists


Today we're going to veer off a little from healthcare and the virus...

The world of surveillance is a murky one, as you can well imagine.  In my early days of tech fascination I didn't really have much of an interest in digital security.  Like many people I figured if I wasn't doing anything to be concerned about, why would I worry about someone seeing what I did online or otherwise. The old adage of "I have nothing to hide" was how I looked at it.

However, with HIPAA and then the proliferation of identity theft and the like, my interest was triggered and I began to pay more attention to the security side of things.  It wasn't all consuming, but it for sure was more than a passing fancy.

My concerns increased when I long ago learned that not only could law enforcement do digital monitoring (however a search warrant was needed) but that there were companies out there who would sell incredibly powerful monitoring software to anyone who had the cash to purchase it.

I had always thought that governments employed cyber experts to create software that they could use to find "bad guys" who needed to be caught.  My naïveté didn't consider that there was money to made in that market.  

As it turns out, smaller countries with less money to spend than the United States, didn't have the financial wherewithal to have cyber teams creating software.  Instead they turned to a dark underworld of 'hackers for hire'.  There were 2 in particular that I began to hear about.  Hacking Team was out of Italy and NSO Group was out of Israel.  Both companies created apps that their clients could use to track users phones.

Those users, it turned out, didn't need to be criminals or terrorists.  No, it turned out that these smaller countries were just as concerned about journalists, politicians, activists, and members of non-governmental charities.

If you are interested in a small part of this, take a look at this Google search on Project Raven.  

Now comes a new breaking news story from The Guardian on NSO Group and their mobile device tracking software called Pegasus.  After a cooperative formed between several different research and news organizations, they have managed to put together a pretty incredible story of just part of what NSO Group and their customers have been up to.  

Monday, July 19, 2021

Update on Cosmedent Renamel BULKfill - Correction of June 30 Post


I recently made a post about Cosmedent's composite Renamel BULKfill. 

In that post, it was stated that the material had a depth of cure of 7mm.  However, today I was informed that they had made a mistake in the materials they had sent out regarding this product.  It turns out that the actual depth of cure for the material is 4mm NOT 7mm.  

I wanted to make sure that all of you were aware of this and were informed so that you can make a better decision on whether the material is right for you.

Arguments FOR Vaccination


If you are even remotely following the news, you have heard that Covid-19 cases are once again on the rise.  It appears that the latest genetic change/evolution of the virus, called the Delta Variant, is more highly contagious than previous strains.  That means that even though previous strains were easily passed from one person to another... the Delta Variant is even more virulent and therefore even more dangerous than the previous strains.

Of course, the people who are most susceptible to this latest scourge are... those individuals who are unvaccinated.  Some people do not have a choice.  Either their age or their health history precludes them from vaccination.  However, many others DO have a choice and many individuals are making the choice to NOT be vaccinated.

Now I am all for individual rights.  I understand that masks are not easy to adjust to wearing and I also understand that there is concern about vaccines.  The Covid-19 vaccines currently being administered were created in record time and some people were concerned about potential unseen safety side effects that might show up after administration.  I get that.  I also was not adamant at the start of vaccine distribution that everyone line up.  I felt it was the choice of the individual.  Now though, my opinion has changed.

Current statistics from the U.S. Centers for Disease Control (CDC) show that 48.3 percent of Americans are vaccinated... which is 160,408,538 people.  That's a good start, but it isn't nearly high enough.  The Moderna and Pfizer vaccines have been administered since late December of 2020.  Unfortunately, the state of Missouri (where I practice) is currently at 39.95% and Kansas (where I live) is at 42.81%.  That helps explain why Missouri is currently in the #1 spot for infections and Kansas is not too far behind.

I personally received both of my injections in January.

Part of my desire to be vaccinated was to prove to others it was safe.  If there was some type of horrible side affect that was going to consume me, I'm confident it would have shown up by now.  I truly wasn't horribly concerned about getting Covid-19.  I had access to N-95 masks, surface disinfectants, hand sanitizer, and nitrile gloves.  I had been practicing dentistry post reopening since May of 2020.  I figured that if I hadn't become infected by that time, I didn't need to worry.  However, I took the vaccine so that I could tell others who might have apprehensions that I had done just fine.  I took it for others, not myself.  We also now have over 160 million people who have received the vaccine and side effects numbers are very low.

I also wanted to be sure that I was as safe as possible for my patients, my team members, and those people in the general population that were at greater risk.

That greater risk is something that we need to consider.  It's now well known that some cases of Covid-19 are subclinical, meaning the host shows no symptoms.  It is also well known, that hosts can  be spreading the virus for several days before symptoms arise and those 2 facts are what make vaccines SO important.  You can be shedding viruses with NO symptoms and infecting others long before you know you are ill.

Children under the age of 12 are not yet eligible to be vaccinated and there are others with health challenges that also cannot receive the injections.  At this point, getting vaccinated is not about personal liberties, it is about doing the right thing.  No one wants to be responsible for injuring another person, especially a child.  

The science is sound.  Vaccinations save lives.  If anyone doubts that responsibility, I would refer you to a recent opinion piece that I read.  After reading this heart wrenching story, I challenge you all to think about what this family went through.  Then I offer you another challenge.  Do the right thing.  Get vaccinated.  The risks are slight while the benefits to yourself and others are tangible.

Thursday, July 15, 2021

TrickBot is Back - Watch Your Email Closely


I love reading The Daily Beast.  It's one of my go to sites for all kinds of news.  It's good edgy reporting and if I ever decide to really go full time with my journalistic side (other than my monthly column in DPR), I might just send them my resume.

According to the article I read, the cyber criminals that run TrickBot are back.

TrickBot can be a bit confusing because it's the name of a malicious program as well as the cyber criminal gang that runs it.  The program itself is malware that can steal information from victim's computers and then use it for bank fraud, identity theft, and other bad behavior.

Last fall U.S. Cyber Command and Microsoft took to the battlefield to disrupt both the gang and the malware in order to help eliminate possible problems during the election.   They managed to take servers offline and all sorts of other things that really disrupted TrickBot.

However, like all things digital, what gets hacked can get repaired and now it seems that TrickBot is back.  It appears that the cyber gang has been working on rebuilding the malware and is now re-releasing it on the world.

Keep. your digital security up to date and don't click on any unknown email links.  And also read the story over at the Daily Beast.

Wednesday, July 14, 2021

A Copy of Super Mario 64 Sells for $1.56 Million


As a tech lover, I grew up on video games.  Well I guess that's not exactly true.  The original Atari console came out when I was in college and I played that crazy thing night and day... especially Space Invaders.  So I didn't really 'grow up' on video games, but they were for sure a part of my younger years.

I also loved the Mattel Intelivision system, but my real love began when Nintendo released the Nintendo Entertainment System (NES) around 1986.  The NES was a phenomenal p product for its time and quickly became a 'must have' for many American homes.  As an American male in my 20s, there was nothing better for playing games.  I spent hours in front of the TV that was connected to my NES.

 I've still got that NES and all of the games that I bought for it as well.  However, now I wish I had purchases TWO of each of those games and kept one sealed in the box.

Why?  Well, over the past weekend two Nintendo games sold for incredible amounts of money.  

The first was on Friday when an original version of the classic game The Legend of Zelda sold for $870,000 and then on Sunday a copy of Super Mario 64 sold for... wait for it... $1.56 million.  Amazing, right?

The Super Mario 64 game was actually one of the original games for the Nintendo 64 game console which, I believe, was the third generation of Nintendo consoles.  The Legend of Zelda was made for the original NES.

It's amazing how nostalgia can draw money out of collectors.  personally I wouldn't buy a game I cannot then put into the console, but perhaps the owner has enough money that they can do just that.  

Really when you think about it, that's over $2.3 million for TWO video games.  It's amazing that those items have so much value.  I suppose it goes to show the value of the characters Nintendo created.  I can still remember playing Donkey Kong on a stand-up arcade machine for 25¢ and helping Mario jump over barrels to save the  Princess.  That was over 35 years ago.  I think it's safe to say that Mario is an iconic character that has stood the test of time.

Tuesday, July 13, 2021

DentaQuest Announces 2021 Health Equity Heroes: Champions of The Pandemic


On its inaugural Health Equity Hero Day today, DentaQuest, a purpose-driven oral health care company dedicated to improving the oral health of all, announced its 2021 Health Equity Heroes: Champions of the Pandemic. Now in its seventh year, the DentaQuest Health Equity Hero program celebrates individuals who preserve access to equitable oral care and health care for all. This year, DentaQuest chose heroes who assisted those most at-risk during the pandemic and who continue to expand that access today.  

“As we emerge from the pandemic, it is clear we are at a crossroads in our health system. We must build toward a new, more equitable system that breaks down barriers to care and improves health outcomes for everyone,” said DentaQuest President and CEO Steve Pollock. “These Health Equity Heroes are actively making that health system a reality. Our 2021 class committed themselves to preserving access to care throughout the pandemic for those who often get left behind. We are honored to highlight them on our inaugural Health Equity Hero Day and thank them and so many others who are creating a more equitable future in oral health care.” 

In addition to celebrating and promoting the contributions of the 2021 Health Equity Heroes, DentaQuest is providing a $5,000 charitable contribution in the name of each hero to a nonprofit of their choice.  

The 2021 DentaQuest Health Equity Heroes are: 

 Adele Della-Torre, DDS, co-founded Ready, Set, Smile (RSS) in Minneapolis to deliver trauma-informed, culturally competent dentistry for children across 27 Minneapolis public schools where more than half of the students are of immigrant descent with limited resources. RSS has helped reduce the number of children with untreated tooth decay by 25% and decrease the number of students with urgent needs from 15% to 7% among children enrolled in its school-based oral health program. During COVID-19, Dr. Della-Torre and her team sought partnerships with community-based organizations to continue running clinics and serve many of the children who would not have received any services without RSS. Dr. Della-Torre is using her award donation to continue the work of Ready, Set, Smile.  

Kadambari Rawal, BDS, CAGS, MSD, FASGD, FICD, FACD, geriatric dentist and Clinical Assistant Professor at Boston University’s Henry M. Goldman School of Dental Medicine, is an oral health advocate for older adults living in long-term care; a growing population with glaring deficiencies in care access. As the pandemic restricted several critical services at long-term care facilities, Dr. Rawal helped implement teledentistry and on-call emergency oral health care protocols for the provision of essential dental services to at-risk patients. Her work was featured in Boston District Dental Society and Special Care Dentistry. She also co-authored a chapter in Dental Clinics of North America, highlighting the growing oral health needs of older adults. With faculty appointments at BU and Harvard University, Dr. Rawal is dedicated to educating the next generation of dentists in geriatric care. Dr. Rawal is directing her award donation to the Smiles for Success Foundation and AID’s COVID Relief Fund for India. 

Yashashri Urankar, DDS, and chief dental officer at Community Health Centers of South-Central Texas, partnered with local emergency departments and urgent care centers throughout the pandemic to continue oral health care for the 20,000 patients the centers serve across the most vulnerable communities of south-central Texas. While telehealth played a significant role in continuing doctors’ visits and behavioral health appointments, it was not yet permitted for virtual dental appointments. Dr. Urankar advocated for the authorization of teledentistry during this time and supported Texas HB 2056, which Governor Abbot signed into law in June. Dr. Urankar is supporting Gajanan Maharaj America Devotees Parivar and Central Texas Food Bank with her award donation. 

Debbie Oswalt and the Virginia Health Care Foundation (VHCF) have helped uninsured Virginians and those in hard-to-reach communities receive medical, dental and mental health care for nearly 30 years. By investing more than $57.5 million to help establish and expand many of the state’s health safety net clinics, VHCF has enabled more than 3.5 million patient visits. Oswalt has also led the growth of Virginia’s dental safety net by funding more than half of the 100 clinics that currently serve the communities. In addition, VHCF has generated $6.3 billion in free medications for uninsured patients with chronic illnesses, and enrolled more than 125,000 Virginians, including uninsured children, in state-sponsored health insurance. As the Executive Director of VHCF, Oswalt’s advocacy work for Medicaid adult dental benefits helped secure the approval of the bill in 2020, enabling more than 750,000 Virginians to become eligible for comprehensive dental benefits. As the bill takes effect, Oswalt plays another important role: ensuring that Virginia’s dental safety net clinics are able to manage the influx of new adult dental patients. Oswalt is directing her award donation to the Virginia Health Care Foundation.  

Karen Fields-Lever, DDS, is the president and owner of 28 to Brush which offers preventive oral health services to the Chicagoland area and more than 16,000 Chicago public school students. These students have diverse racial, ethnic backgrounds and typically reside in under-resourced communities. Through her work in the schools, Dr. Fields-Lever has increased access to treatment for children by 50% year over year and introduces children to the dental profession. During the pandemic, Dr. Fields-Lever continued treating patients through teledentistry and emergency visits. As one of the few Black female dentists in the Chicagoland area, Dr. Fields-Lever is a STEM champion for young students and a mentor to aspiring women pursuing careers in oral health care. Dr. Fields-Lever is sharing her award donation with several community nonprofits, including Black Village Foundation, Urban Initiatives, Breakthrough, Spelman College and Oak Grove AME Church. 

David Jourabchi, DDS, of Pacific Dental Services (PDS) Foundation Dentists For Special Needs, specializes in treating patients with an intellectual or developmental disability (IDD). Due to the lack of dentists who specialize in this field, oral health care remains one of the most common unmet health needs for individuals with IDD. Dr. Jourabchi provides the appropriate accommodations for his patients, including desensitization, to combat challenges with physical disabilities as well as sensitivity to sensory stimuli like speech, sound and light. The dental experience begins in the reception area where patients are introduced to a sensory room with tiles, fish tanks with bubbles and galaxy lights that match sensory stimuli preferences. This personalized level of attention extends through the entire visit to ensure patients feel comfortable and safe. Patients who were once unable to complete a dental appointment without sedation are now capable of achieving each step of an appointment without incident. Since 2019, Dr. Jourabchi has treated more than 1,200 patients from across the U.S. and was one of the only dentists to deliver care for patients with IDD during the pandemic. Dr. Jourabchi is supporting Special Olympics of Arizona and PDS Foundation with his award donation.   

Jim Mangia, MPH, president and CEO of St. John’s Well Child & Family Center, quickly mobilized to protect community health in South, East and Central Los Angeles with testing and contact tracing programs, telehealth for triage and consultations, services for the homeless, monoclonal antibody infusion treatments and a vaccine equity program that inoculated more than 266,750 at-risk residents – all while running one of the largest nonprofit health centers in the most under-resourced areas of Los Angeles County, caring for more than 100,000 patients annually. During the past 20 years, under Mangia’s leadership, St. John’s has grown to 20 sites, including three state-of-the-art mobile clinics, and six school-based health centers, one of which was the first to fully integrate dental services. Mangia selected Esperanza Community Housing Corporation as the recipient of his award donation.  

The St. Elizabeth Physicians Pharmacy and Operations team was on the frontlines of the pandemic, playing a major role in COVID-19 vaccinations for educators in northern Kentucky. The team vaccinated nearly 4,000 teachers and school staff within a three-week window, an effort led by Director of Value Based Performance Erica Neff and Director of Operations Jackie Houze. By effectively and efficiently vaccinating the teachers of this region, St. Elizabeth Physicians helped children return to normalcy. Neff and Houze are directing their award funds to the St. Elizabeth Foundation. 

Jeremy Simms Alexander, DDS, introduced the concept of mobile dentistry to his native home of Shreveport, Louisiana, as a way to expand access to sustained oral health care across all ZIP codes, particularly those in under-resourced communities. Since its inception in 2015, Miles for Smiles Mobile Dental Care has brought oral health education and preventive care to 80 Louisiana public schools. As the only dentist in the state fully committed to operating mobile dentistry, Dr. Alexander was able to continue services for these students—bringing his mobile clinic to school sites in three different parishes  across northern Louisiana, offering cleanings, fluoride treatments, sealants, X-rays and exams. For many, Dr. Alexander is the first dentist, and first Black dentist, they have ever encountered and serves as a teacher of oral health and advocate for diversity in the community. He is supporting Holistic Youth Programs for Empowerment, Inc. with his award. 

Charles Madden, DDS, Dental Director of the Good Samaritan Free Health Center, has recruited dozens of volunteer dentists, hygienists and dental assistants during the past 10 years to serve the oral health needs of financially challenged Cincinnatians. The Good Samaritan Free Health Center is a medical, dental, optometric and behavioral health home which seeks to enroll every patient into Medicaid, Medicare, Veterans Affairs services or any other program they might qualify for prior to providing treatment. While COVID-19 shut down dental operations, Dr. Madden and his volunteer staff were still able to provide more than $200,000 in free dental care in 2020. Dr. Madden has transitioned to a part-time COVID-19 vaccine administrator and enabled the Good Samaritan Free Health Center to become a vaccination site for the surrounding at-risk community. Dr. Madden is supporting the Good Samaritan Free Health Center with his award. 

Amarilis Jacobo, DDS serves many roles, including neighborhood dentist, former president of the National Hispanic Dental Society, and leader in the Bronx County Dental Society and the New York State Dental Association. She was a natural addition to Gov. Cuomo’s New York Forward Reopening Advisory Board, where she provided knowledge and expertise on the return of preventive and routine care at dental offices limited to emergency care during the pandemic. Dr. Jacobo has been active in grassroots campaigns to promote oral care and prevention, including spending weekends to champion COVID-19 vaccinations in her neighborhood. In recognition of her community contributions, Bronx High School awards a health careers scholarship in Dr. Jacobo’s name. Dr. Jacobo is directing her award donation to the New York State Dental Foundation.  

Marsha Wilkes Beatty, BS, MPH, is a champion for oral health improvement in Oklahoma and across the U.S. As Assistant Professor of Research, Director of the Senior Externship Program at The University of Oklahoma College of Dentistry and Chair of the Oklahoma Oral Health Coalition (OOHC), Beatty helped Oklahoma adapt and refine a grading system that evaluates the oral health care performance of each state. Because Oklahoma lacks access to adequate dental care for so many of its citizens, the state scored poorly, receiving a “D.” As thousands more Oklahoma adults become eligible to receive dental benefits through Medicaid expansion, Beatty is providing leadership for coalition partners and stakeholders to create the state’s first strategic oral health plan since 2009. At the college, she reinforces the importance of rural dentistry and has developed a program which gives seniors an enhanced opportunity to experience dentistry in rural and metropolitan communities where access remains a particular challenge. Beatty is spreading her award funds among multiple nonprofits, including Neighborhood Services Organization, Good Shepherd Ministries, Catholic Charities of Eastern Oklahoma, Oklahoma Dental Foundation, Inc., and the OOHC.   

In addition to highlighting this year’s Health Equity Heroes, DentaQuest will be celebrating all champions of health equity as part of Health Equity Hero Day and encourages partners and individuals across the country to join in on Twitter, Facebook and LinkedIn using the hashtag #HealthEquityHeroDay. 

Monday, July 12, 2021

VOCO's VisCalor Bulk Continues to Impress


I wanted to make a post today to bring readers up to speed on my continuing work with VisCalor Bulk from VOCO.

I began working with the material in October or November of 2020.  I had always been a fan of heated composite.  I had been using the Calset device from Addent for at least 15 years.  I *loved* how easy it was to place and work with warmed composite.

When VOCO approached me about working with VisCalor Bulk, the idea of a heated AND bulk filled material was immediately intriguing.

Since my initial exposure to the material, I've had nothing but good experiences with it.  The warming gun makes the material easy to place and the redesigned compule makes placing the material simple and effortless.  

VOCO redesigned the composite compule for this material.  The tip is 10mm in length and 2mm in diameter.  That means that the tip can be easily placed to the floor of the proximal box in a Class II restoration.  This allows the operator to easily fill the prep in a "back filling" type procedure while keeping the tip immersed in the material.  That means voids are not a concern.  All you need to do is prep, heat, fill, and sculpt.

When you add to all of that the fact that the material is incredibly aesthetic, it's a win-win-win product.  The case below is a great display of the material's aesthetics.   The preoperative shade was taken and determined to be A-2.  After competing the preparations and getting ready to fill, we realized that we were out of VisCalor Bulk shade A-2.  I discussed the situation with the patient and it was decided to proceed with shade A-1.   As you can see from the post-fill photo, the shade, even though wrong, still worked out very well.  The takeaway from this case is that if the material looks this good using the wrong shade, imagine what it will look like when you use the right shade.

Now that you've seen the photos, I can say with certainty that is I write this, VisCalor Bulk is one of the most aesthetic materials  I have ever used.

I now have about 9 months of clinical experience with the material and I cannot remember one bad situation with it.  The product was highly recommended when I tested it... and I still rate it as highly recommended today.  You owe it to yourself to check this out!

Thursday, July 8, 2021

Opiod Overdoses are Up and Prescriptions are Down - Did All of This Legislation Accomplish Anything?


I was reading this article in one of my favorite news sites and I couldn't help but wonder what all of the "clamping down" on prescriptions has gotten us.

I will readily admit that the prescribing pendulum had gotten way to one side.  People were getting pain medicine for darn near *everything*.  Perdue Pharma even managed to convince the healthcare field that pain was a vital sign.  That was wrong.

However, instead of 'pumping the breaks' and working on educating professionals to cut back prescribing AND providing more treatment, legislatures *stood* on the brakes and began passing all kinds of laws that limited prescribing.

No one seemed to figure out that overdoses were a sign of addiction.  The unfortunate result of all of these pain pills flying around was that lots and lots of people got addicted.  That even applies to good God fearing folk who took them as directed.  After a while even following the rules creates physical dependency.  Then suddenly all of those people who were dependent were cut off... cold turkey.

And guess what?  When you cut off the legal supply and people start going through withdrawal, the black market of illegal drug sales is more than happy to make up for the sudden legal deficiency.

Illegal drugs aren't regulated.  Users don't know what they are taking, but they take what they are sold because withdrawal is a horrible, painful thing they want to avoid. Unfortunately the drug dealers are now lacing their products with Fentanyl.  That provides a significant high, but is also highly, highly addictive.  There's also a pretty low margin of safety.  A *tiny* amount of Fentanyl can be fatal.

Here's a scenario I'd like you to consider.  Someone being treated for chronic pain becomes physically dependent on hydrocodone.  They go to their doctor for a refill and are told the doctor will no l longer refill this prescription.  A day or so after the last pill they start to get sick... really sick.  The withdrawal is horrible.  The person can't work, can't sleep, can't eat, and are doing time in the 9th circle of hell.  In desperation they buy illegal pills that they are told are hydrocodone.  But instead, they get hydrocodone laced with Fentanyl.  Within a few days they are REALLY addicted and the cycle continues.  More illegal pills, more Fentanyl, more addiction.

Society has let this person down.  They were left with a physical dependence and no way to cope with it.  No treatment, no weaning off, no nothing.  But hey, fewer prescriptions are written so it's all good right?

A philosophy professor once told me "you cannot legislate morality" and truer words were never spoken.  As opioid and opiate prescriptions have gone down, illegal drug sales including for heroin have gone up more than proportionately.  Basically we've traded legal drugs for illegal ones and people are STILL dying.  It's sad.

I feel where the mistake in all of this is, was a lack of addiction and dependence treatment.  Leaving folks to go through withdrawal with no support system is inhumane.  You cannot just cut the supply, you have to change the entire dynamic.  People are still dying.

Wednesday, July 7, 2021

KaVo and A-Dec Announce a Collaborative Effort to Improve Dentistry

 This information is pretty much "hot off the press".  While I had heard a couple of rumblings about this from sources, I wasn't really sure if this announcement would really come to pass.  As those of you in dentistry know, KaVo and A-Dec are two hugely successful and quality minded companies.  I'm intrigued to see what they come up with.  The press release is pretty vanilla, but you can read it below.  If I find anything out that I can share, I will post it here...

A-dec and KaVo, two of the most respected names in the dental industry, announced a new collaboration to deliver premier products and world-class service to dental professionals worldwide – Excellence Amplified. KaVo’s legacy of world-class performance and innovation combined with A-dec’s legendary reputation for quality and customer service makes this a powerful collaboration.

A-dec President, Marv Nelson, announced the collaboration: “The dental industry is all about human connection, and the positive relationships we forge to work for the betterment of dentistry. A-dec’s commitment to this mission starts with our #1 core value, Concern for People: our employees that create superior customer solutions of the highest quality, and our valued partners that share our high standards for service and dedication to our mutual customers. Our new collaboration with KaVo represents our unwavering commitment to the betterment of dentistry worldwide.”

KaVo Vice President & General Manager, Ronald Linke, added: “It’s a special opportunity when two industry leaders, each with a proven track record of excellence in their respective fields, can come together and collaborate with a mutually shared vision. We’ve devoted our business to providing premium-quality products to dental clinicians for over 100 years. We continuously seek to improve our business and service to our customers. This collaboration, with an organization that demonstrates the same level of commitment to its customers, presents a clear opportunity for KaVo to support dental professionals in new, innovative ways.”

About A-dec: With a mission to work for the betterment of dentistry worldwide, A-dec is one of the largest privately-owned dental equipment manufacturers in the United States and recognized as a global leader in dental solutions. The company markets its manufactured dental products, including dental chairs, delivery systems, dental lights, dental furniture, and mechanical room air compressors, vacuums, and water control valves, and a new growing line of infection control products: A-dec 360™ (

About KaVo: For over 100 years, KaVo employees have been developing, manufacturing and selling high-quality products that set new market standards in the dental industry. KaVo has built its reputation driving quality, precision, and innovation in a continuous endeavor to achieve “Dental Excellence”. KaVo is one of the world’s leading creators of equipment for dental professionals, including skillfully designed dental instruments, best-in-class imaging products and state-of-the-art dental treatment units. It is passion for excellence that enables KaVo to deliver the premium dental solutions worldwide (

Tuesday, July 6, 2021

Springfield Missouri Hospital Runs Out of Ventilators as Spike in COVID Cases Continues


This seems like a headline you would have seen in June of 2020 and NOT in June 2021, but here it is.  As I stated in a post last week, the number of COVID infections in the state of Missouri has been increasing rapidly.

The problem seems to be related to a fairly low number of vaccinated individuals in the state.  Unfortunately the Delta Variant has managed to make it to the Show Me State and since it is highly infectious and easily passed from one individual to another, it has caused cases to rise at an alarming rate.  Missouri currently has 39.16% of its population fully vaccinated.

The Delta variant also seems to be better at infecting younger individuals for some reason.

This low vaccination percentage has helped cases increase by 51% over the most recent two weeks.  Needless to say, that's an alarming number.

Now come word out of Springfield, the state's third most populated city, that they are out of respirators at Mercy Hospital.  That's a serious problem when dealing with a virus like COVID-19 that attacks the respiratory system.  According to reports, Mercy Hospital was using 47 respirators at the time and had none left in inventory.  Granted 47 is not a huge number, but if you are in need of one and you are patient 48, that number seems much more important.

It's unfortunate to learn of situations like this when there is a vaccine available and it is being distributed for free.  My personal feelings are that I would rather take my chances on the vaccine than be on a ventilator, but other opinions obviously differ from mine...

Thursday, July 1, 2021

Missouri Sees Huge Spike in COVID Variant D Infections - Numbers Surge


For you readers who don't know, I practice in Lee's Summit, Missouri which is a suburban area in the southeast corner of the Greater Kansas City area.  Because of my practice location, I was less than thrilled with the state when I started seeing headlines stating that Missouri is either leading or almost leading the United States in new COVID-19 infections.

It seems that the vaccination rate in the state of Missouri is very low.  Estimates are that 44% or residents have received one dose of the vaccine with 38% fully vaccinated.  However, in one county only 13% have received at least one dose.

Because of this low number of vaccinations, the Variant D strain appears to be running rampant.  I saw a recent article that stated 2 hospitals in Springfield, Mo had a combined 153 patients admitted when a few months ago that number was about 30.  

The Delta Variant (also known as Variant D) is highly infectious.  This is the strain that was first spotted in India not too long ago and has already spread rapidly.  

The good news is that individuals that have been fully vaccinated appear to also have immunity to the Delta Variant.  The bad news is that until more individuals are vaccinated, this variant has the potential to rapidly spread through susceptible populations.

I understand that some people have concerns about the vaccine.  They feel that it was rushed to market and could. potentially have unforeseen effects in the weeks and years to come.  I get that.  This also reminds me of a great book I read a few years ago called The Psychology of Fear.  In the book, the author discussed the 9/11 risk.  The year after 9/11, the number of air travelers decreased significantly.  It was based on the simple fact that many people feared being in the next wave of highjacking and losing their life in a plane crash.  Many people who had to travel, did so by car instead of flying.

The thing about this logic is that  statistically automobile travel is *much* more dangerous than flying.  Tens of thousands die every year on the highways, while an occasional plane crash might kill a few hundred.

The net result was that in the year after 9/11 automobile deaths skyrocketed as travelers that would have normally been flying were driving.  That means that many individuals who would have lived had they flown, died because they were driving.

What we are seeing in some areas with low vaccination rates are basically the same situation.  Individuals that have a fear of the vaccine actually end up catching the Delta Variant.  Of course, COVID-19 statistically is only fatal in about 2-3% of cases.  However, eve3n if you get only a mild case, you could easily infect someone who can't take the vaccine due to some health condition.  If that person succumbs to the virus, that's a horrible thing to be responsible for.  All things to think about...