Wednesday, December 28, 2022

FDA Clearance is Granted to Denti.AI for Auto-Charting Software


A few years ago I did some work with Denti.AI from a consulting standpoint.  The concept of using machine learning in dentistry was young back then, but I definitely got a glimpse of the future in my work with them.

Now the company has a huge announcement as they have received FDA clearance for their auto-charting software.  Getting the blessing of the FDA for a product is an incredibly big deal.  I have not had a chance to work with their charting system, so all I can state at this point is what the FDA has approved, but I can tell you that charting is very time consuming and having it automated would be a welcome addition to any practice.

Here is what Denti.AI has to say about their recent FDA clearance...

 -- Denti.AI Auto-Chart, an AI-powered software developed by Denti.AI, has become the first and currently only dental auto-charting product cleared by the FDA.

 The device can assist dental professionals in the interpretation of intraoral and extraoral 2D x-ray images by detecting and numbering teeth and missing teeth. It also aids in detecting dental structures added through past restorative treatment, including implants, crowns, pontics, endodontic treatment, and fillings, as well as their attributes, such as affected surfaces.

Denti.AI Auto-Chart's quick and reliable imaging-based odontogram charting complements Denti.AI Voice, which is used at hundreds of US and Canada clinics commercially to improve the speed and accuracy of perio charting. Combined, these products revolutionize charting tasks and drive better patient outcomes and bottom-line growth.

The product integrates directly into any Practice Management System (PMS) and Imaging software systems creating seamless workflows for dental professionals. By automating the entire data entry process, Denti.AI Auto-Chart produces highly accurate and complete patient charts. While studying its efficacy, the FDA determined that the results of Denti.AI Auto-Chart exceeded the predefined acceptance criteria and demonstrated a 70% reduction in time and effort required to create dental charts.

"This is a breakthrough for the field as one of the first users of Denti.AI Auto-Chart," Dr. Slazcka said, "I believe tooth numbering and existing charting is a huge hassle for staff. With Denti.AI Auto-Chart, even at 80% accuracy, it is much easier for them to take a template and work off corrections rather than inputting all variables."

"We are thrilled to offer this product that makes dentists' and hygienists' lives easier and improves their productivity and outcomes for the patients," said Denti.AI founder and CEO Dmitry Tuzoff. "With Denti.AI Voice, we changed the way perio charts are created, and everyone has asked us about odontogram charting, so now Auto-Chart will provide a significant and long-awaited addition to the dental professionals' automation toolkit."

Denti.AI founders' breakthrough research paper, Tooth Detection and Numbering in Panoramic Radiographs Using Convolutional Neural Networks, Dentomaxillofacial Radiology, 2019, established the scientific foundation of the revolutionary Auto-Chart tool. The study remains a top ten most-cited academic paper for AI in dentistry worldwide.

A US patent protects the technology that has also been adopted in a commercial partnership with P&R Dental Strategies, making it an essential tool for any dental insurance claim review from a clinical standpoint.

Denti.AI recently closed a pre-Series A round of funding. The infusion of capital led by one of the largest investors in dental technology will allow Denti.AI to bring more intelligent solutions to dental practices and reach remarkable milestones.

About Denti.AI

Founded in 2017, Denti.AI uses AI to detect pathologies, past treatments, and anatomical features from dental x-rays and voice commands, helps find diseases earlier, increases dentists' and hygienists' productivity, and provides more accurate records. Its products are integrated with practice management systems to automate workflows of dental groups in North America with hundreds of active users.  

Monday, December 26, 2022

Research into Bone Conduction from Dental Implant for Hearing Aids

 This is one of the coolest things I've read about in dentistry for quite a while.  In the past I've read that the military uses speakers that attach the the zygoma or the mastoid process that conduct sound through bones in the skull.  They refer to them as "bone phones" which is obviously a play on the term headphones.

What I'm going to tell you about is pretty fascinating.  It seems that researchers are working on a way to use dental implants to function as an adjunct to ear place hearing aids.  Since implant are actually connected to the bone of the maxilla or mandible, the theory is that sound could be transmitted through them that would then be picked up by the inner ear.

I wold think that the maxilla would be preferred since the mandible is only connected to the body via soft tissue which would impede the conduction, but the idea is a fascinating one.

The official scientific paper is behind a pay wall, so all you can read is the abstract, but the good news is that Medscape has a pretty good summation of the paper.  You can read the Medscape article here.  

Thursday, December 22, 2022

NORAD Tracks Santa - It's That Time of Year!

I love the Christmas Season!  No matter what your beliefs are, I think that for about one month each year, we can be nice to one another!  So no matter what your beliefs in a higher power "are" or "are not" I still say "Peace on Earth and Good Will Toward Men!"

So now that I've said that, let's get on with probably my fave post of the whole year.  Every year I love to post about and promote the NORAD Santa Tracker service.  

You can even track Santa from your GM vehicle via OnStar.

Every year lots of volunteers in our military answer the phones and provide info on Santa's journey.  It's one of the coolest things of the holiday season.  My family called one year and we were really impressed to get the info on where Santa was and when he would be in our area.  I cannot say enough thank yous to all the hardworking members of the U.S. Military and especially those who donate their time to this special cause!

If you are interested in tracking the big guy, here is a link to all of the available ways to do that!

I won't go into all of the details in this post, but NORAD has tons of info on the Santa Tracker and all that it entails.  You can access all of that info here.

Merry Christmas to all!

Wednesday, December 21, 2022

Do NOT Disclose PHI in Online Reviews!


Consider today's post an early Christmas present!

Not to be flip about this, but this is a *serious* issue.  This year the Office of Civil Rights
(OCR) has fined and forced implementation of a Corrective Action Plan (CAP) on 2 separate dental offices in 2 separate HIPAA violations.

There is an old adage "discretion is the better part of valor" and that certainly applies here.  It seems that 2 separate offices received negative Yelp reviews.  The doctors who owned the practices responded to the complaints and publicly revealed PHI (Protected Health Information) which is a violation of Federal HIPAA laws.

If you are interested, the OCR settlement release for one of the practices can be read here.

I'm providing the link not to embarrass the office, but to provide knowledge to others that might prevent something like this from happening to another office.  The press release basically explains that offices cannot do these types of things.  Revealing PHI is *never* acceptable.

My suggestion would be to post that you are sorry for the incident and would be happy to discuss in person.  Hopefully this post can help keep someone else from a HIPAA violation.

Tuesday, December 20, 2022

he Academy of Laser Dentistry Publishes the Latest Edition of the Journal of Laser Dentistry


The Academy of Laser Dentistry (ALD), an international, professional membership association, announced today the availability of the latest edition of its peer-reviewed serial publication, the Journal of Laser Dentistry (JLD).  

This issue provides practical advice from some of laser dentistry’s most knowledgeable clinicians, researchers, and educators.  Highlights of this 153-page digital issue include the following:

An examination of the effect of photobiomodulation on chemoradiation-induced xerostomia and oral mucositis

The effectiveness of various laser wavelengths for desensitization of hypersensitive dentine

The advantages and limitations of a closed, Er:YAG laser-assisted surgical approach to esthetic crown lengthening

A technique for low-energy ablation of oral lichen planus with a 9300-nm CO2 laser

Phototherapy for pediatric obstructive sleep apnea.  

What’s more, these clinical topics are complemented by insightful interviews, thought-provoking commentaries, a compilation of photobiomodulation resources, and more. View the complete table of contents. 

The latest edition of the Journal of Laser Dentistry and other recent issues are immediately accessible to ALD members at as one of several valuable member benefits. Find out more about ALD individual and corporate memberships at

About the Academy of Laser Dentistry:  

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

For updated news and information, follow the Academy on Facebook, LinkedIn, and Instagram. 

Monday, December 19, 2022

The Blog Continues...

 As many of you noticed, I took a few days off last week.  My apologies for not making an announcement here.  I was preparing for a webinar on Thursday evening and I got so involved in that, I simply forgot to tell all of you blog readers that I wasn't going to be posting.  Sorry about that!

As you have all found out as of late, my professional life is changing a bit.  Starting in 2023 I won't be the actual practice "owner" any more.  Instead, I'm flipping places with Dr. Brunker.  She will be owning and running the actual business aspect of things while I will become an associate of the new practice "Advanced Dental Associates".

I'm really excited about the changes.  As most of you know, I have been a dentist for 35 years.  That has come with a lot of meetings and paperwork in addition to solving problems like equipment maintenance and other things.  And... of course on top of all of that, I've had the things that come with the "other" aspects of my career.  I've been taking care of patients for 32 hours per week, writing and editing for each issue of Dental Products Report, doing DPR Product Test Drives, working as Missouri State Peer Review Chairman, doing expert witness work in malpractice trials, and *then* I get to have dinner!

Seriously, I've burned the candle at both ends AND in the middle.  The one thing that I might classify as a positive from the pandemic is that it helped me to put things in perspective.  Even before the nightmare of 2020, I had begun to stop and look at where my life would go in its "next" stages.

What I discovered with that introspection is that I needed to get the business part of my business off my plate.  I am looking forward to helping patients and doing all of the other things I have been doing, but I finally won't have to to do the "business" part that I really haven't enjoyed for a few years now.

And I will say one of the things that I am most proud of is that my office and practice will be handed off to Dr. Rachel Brunker.  Dentistry is a very personal thing and I am extremely proud that my patients and the members of the office team are not being turned over to a corporate dental entity with the compassion of Arnold in The Terminator.  No, that will all be handled by Dr. Brunker who is one of the sweetest, most compassionate, and (most importantly) skilled doctors I know.

Dr. Brunker, Dr. Poppa, and I are ALL looking forward to the future.  AND as readers of The Blog, I want all of you to know I'm going to keep on posting my updates, news, and ramblings.  So just because I took some time last week, doesn't mean I'm gone.  I'm not going *anywhere*.  However, I DO want you to know that from now until the New Year, posting may be a bit "hit and miss".  As regular readers know, I am always a bit hit or miss at this time of year so if you don't see a post for a day or two, don't let it worry you... I'll be back.  You are not getting rid of me THAT easily!

Monday, December 12, 2022

The Bar... and the Backstory of Flucke and Associates


Last Thursday the office crew and I went out for our annual Christmas shindig.  Most of you know our current location (shown in the picture above).  We've been in that office for 15 years!  However, what a lot of you don't know is that for the 18 previous years before the new office, I worked out of 1400 sq ft space in a strip mall not far from our current location.

When I moved out of the old strip mall space, it was vacant for quite a while.  Then... of all things a small watering hole called, appropriately, The Bar, opened up in the old dental office.  In the years that followed, I had been in there one time for a cold one with a few of the staff that had worked there with me.

Since I'm about to turn the reins over to Dr. Brunker at the end of the month, I thought it would be fun it I took all of the current staff to The Bar as a kind of farewell to my practice ownership.  We went out and had a great lunch and then headed over for the final adult beverage only to find... The Bar had closed the week before!

Since we couldn't actually go inside the old office, a passerby was nice enough to snap this photo of all of us in front of the old place.  I was a bit bummed, I must confess.  I thought it would be a good time for one last beer.  The sign in the window replaced my neon  "Dentist" sign with the giant neon tooth on it.  I had to leave that sign behind when I moved.

It's kind of funny to see all of us in front of that window.  We would have had a tough time fitting all of us in the place if I hadn't moved 15 years ago.  So it's not only the end of my practice ownership... it turned out it's also the end of The Bar... which is a sad event as I hate to see any small business close.

The good news is Advanced Dental Associates will be around for generations to come.  Sometimes when something ends, even better things are just beginning.

Thursday, December 8, 2022

Coming Soon... Advanced Dental Associates


Changes are afoot here are the office.  The following announcement went out to all our patients yesterday, but now I'd like to share the news with all of you who read the blog.

The great thing about this change, from my perspective, is that I will have more time to do my evaluations, product testing, and other parts of my "second job".  I'll be able to devote more time to those fun projects since I won't have to be meeting with accountants and doing all the other little details that come with owning a business.  Now I'm relieved of those business responsibilities.  So read on for the details of the changes here at the office...

We are about to finish our 15th year in our new location! I am amazed that the time has gone so quickly and I am also so incredibly grateful to all of you for trusting us to provide your oral healthcare. Since the age of 3, dentistry is the only thing I ever wanted to do and I am so blessed that all of you have helped make that dream a reality.

I graduated from the University of Missouri - Kansas City School of Dentistry in 1987 & opened my office in Lee’s Summit in 1989. Some of you have been with me so long that I have seen you get married, have children, watched them grow up, and now I am treating your grandchildren. I’m hard pressed to think of a greater honor than that.

Of course that also means that I have been practicing for a while now. In April I passed my 35 year mark as a dentist. I can remember when simply “being” 35 seemed old and now I’ve been a doctor that long. The time has passed pretty quickly.

Now with all this talk of time passing I do NOT want you to think I’m retiring. Let me say that again, “I am NOT retiring”. I’ve come to the conclusion that I simply love what I do SO much that I am not ready to hang up my spurs yet.

However, there will be some changes happening in January and I want you to be aware of them. I have decided to sell the practice to my sidekick Dr. Rachel Brunker. Because of that, the name of the office will change. The sign out front and our website will be “Advanced Dental Associates”.

Other than the name change, everything else will pretty much stay the same. We will have the same hours, the same caring staff, and the same attention to detail that you have come to expect from us. Basically, I feel the need to put the pieces in place for the next generation. In the last 10-15 years I’ve given thought to the fact that at some point someone else would be responsible for caring for all of you. Having that thought in mind, I looked for someone that shares my passion of taking the best care of people that I can. I absolutely *love* what I do and that is mainly because of my patients. I felt it was important to find a doctor I could transition my office to that would try as hard as I do to give you the best possible care.

I’ve known Dr. Brunker for quite a while now. Some of you may even remember when she shadowed in the office before heading to dental school. She is an incredible doctor and clinician with a strong desire for education and a love of healthcare technology. I know in my heart that she possesses all of the special qualities I was looking for in the person to lead the practice into the future and to take care of all of you.

This transition is made even easier with the continued presence of Dr. Michael Poppa. He joined our practice this past summer and has been a tremendous asset to our team. If you haven't met him yet, trust me, you are going to love him! He has great skills, is compassionate, and is the kind of man that I respect and admire. I am SO glad he joined us!

I will continue to be in the office, just like always. Dr. Brunker will be in charge and one of my goals is to be as good a helper in this transition as I can be. The most important part of this change is that this office will continue on the path that got us here. That means, as a patient, you really won’t notice much difference other than the name change.

We all love what we do here and I am really excited to see that things are taking shape for the next generation of patients. In the future, those grandchildren I am now taking care of will be able to bring their children to the office and know that the commitment and level of care will be the same!

I am SO proud of Dr. Brunker. She’s going to be an amazing practice owner. I am also SO grateful to all of you. This all started from when I was a little boy with a dream, but it has been ALL of you that have made those dreams come true!

I look forward to seeing you soon and I look forward to continuing my role in your care.

Please join me in congratulating Dr. Brunker!


Dr. F

Wednesday, December 7, 2022

Introducing FULL CONTACT™ 
Cosmedent’s Sectional Matrix Bands


Cosmedent’s FULL CONTACT™ sectional matrix bands have a multitude of advantages for the clinician: they are ultrathin and easy to place, pre-contoured for complete contact and resilient, holding their shape once placed. These matrix bands can wedge from both buccal and lingual sides ensuring a complete gingival seal. They can also be used with any ring system or alone. FULL CONTACT sectional matrix bands are available in both large and small sizes.

For more information, call our customer care representatives at 800-621-6729 or visit us online at

Tuesday, December 6, 2022

Owandy Highlights the Integration of its QuickVision 3D Software with the Medit i700 Digital Scanner


edit i700 Users Can Now Use Owandy’s 3D QuickVision Software

as Their Digital Implant Workflow Hub

Owandy Radiology Inc., a global leader in the manufacture of dental radiology hardware and imaging software, will highlight the recent integration of its QuickVision 3D implant planning software with the Medit i700 intraoral scanner product line at booth #4015 during the Greater New York Dental Meeting. 

Owandy’s QuickVision 3D Software is a comprehensive, open architecture implant planning solution that can serve as the heart of Owandy’s extensive product suite or as the digital workflow hub capable of integrating digital technologies from other manufacturers.

 The Medit i700 intraoral scanner features plug and scan simplicity, super-fast scan speeds and an open architecture for the efficient sharing of patient records. The i700 wireless scanner delivers superior convenience and mobility  

“Thanks to open architecture, QuickVision 3D Software and Medit scanners integrate seamlessly,” says Owandy’s Vice President of Sales and Marketing, Boris Loyez. “Medit i700 users can now take full advantage of QuickVision’s impressive capabilities including its extensive AI-powered auto-matching. QuickVision 3D software also includes comprehensive implant libraries from all major manufacturers. 

About Owandy’s QuickVision 3D Software:

Owandy’s QuickVision 3D software creates a comprehensive planned treatment report and surgical guide in .STL format within minutes. The report can then be sent to a lab, shared with a colleague, or sent to a 3D printer.

QuickVision was designed to be the hub of a digital workflow system that features five steps and corresponding solutions. This includes: DICOM Data acquisition, which entails CBCT exploration by using Owandy’s I-Max 3D or I-Max Ceph 3D; .STL data acquisition; implant planning that comes with a complete cloud-based implant manufacturer library and bone density measurement guide; surgical guide design, with the software guiding users through the treatment planning and surgical guide process; and file export for manufacturing via CAD/CAM milling unit, lab or 3D printer. 

Since the Greater New York Dental Meeting,  Owandy will be running several show specials, stop by booth #4015 or download the flyer at

Learn more about the full line of Owandy products by visiting, calling 516-858-5695 or sending an e-mail at  Distributor inquiries are always welcome.

About Owandy Radiology, Inc.: 

Headquartered in France, and serving North America from Roslyn, New York, Owandy Radiology is a global leader in the manufacture of dental radiology hardware and imaging software. Its products are distributed through dental dealers across the USA, and in more than one hundred countries world-wide, on every continent. For more information, visit

Monday, December 5, 2022

A Momentous Day for Children’s Oral Health - from the Canadian Dental Hygienists Association


Ondina Love, chief executive officer of the Canadian Dental Hygienists Association (CDHA), was honoured to join The Honourable Jean-Yves Duclos, federal minister of health, today for a historic announcement on a momentous day for children’s oral health in Canada.

 Across the country, dental hygienists are celebrating today’s official launch of the Canada Dental Benefit because this new program will help children access the essential oral care needed to prevent disease and improve overall health. Dental hygienists see the effects of poor oral health firsthand and that’s why they, alongside many other oral health care providers, have long called for better access to preventive oral care services for children. 

 “Today’s announcement on the Canada Dental Benefit will be remembered for generations,” said Love. “Dental hygienists have consistently called for increased access to preventive oral health care for children, and this government commitment does that.”

 “CDHA represents the sixth-largest regulated health profession in Canada. With a dental hygiene workforce of over 31,000 professionals, we have the capacity to deliver essential oral health services in dental offices, school clinics, independent dental hygiene practices, and mobile practices,” remarked CDHA President Anne Caissie. “The passage of this national dental care bill into law is a historic accomplishment of Prime Minister Trudeau and his government, working with the NDP to support the oral health of children in Canada,” added Caissie.

 CDHA and dental hygienists across the country applaud the federal government for investing in children’s oral health and look forward to future phases of this program reaching even more Canadians.

CDHA is the collective national voice of more than 31,000 dental hygienists in Canada, directly representing 21,000 individual members, including students. Since 1963, CDHA has worked to advance the profession and promote the importance of oral health. Dental hygiene is the sixth-largest regulated health profession in Canada, with professionals working in a variety of settings, including independent dental hygiene practice, with people of all ages, addressing issues related to oral health. For more information on oral health, visit 

Thursday, December 1, 2022

The Number of Data Breaches in Healthcare Doubled in Three Years...

 I happened to come across an article recently on the website that dealt with the continuing problem of data breaches in healthcare.  Due to the amount of computing infrastructure in healthcare, combined with the NEED for fast access to data to save lives, that sector of the market is a big target for cyber criminals.

What I get upset about is the aspect that criminals mucking around in hospital networks could very easy cause loss of life.  Now I realize that also applies to lots of other sectors that are battling Ransomware and other threats... the Colonial Pipeline hack could have affected EMS or other emergency departments that save lives.  However, hacking hospitals seems to have a very direct "cause and effect".

I suppose that criminals don't let those trivial details really enter into the mental equation, but it should.  The basic idea is that because of the need to access medical data quickly and efficiently, hospitals will face huge pressure to pay a ransom as the data is in the best interest of the patients.

Dental offices, while not frequently dealing with life and death issues, can still be targets of cyber criminals.  However, since many dental offices are still privately owned, the potential for high dollar payouts are not there.  Large corporate dental clinics might be better targets for ransomware, simply because they have more money for ransoms, but there is also the fact that encrypting a private practice system would take the owner's livelihood away and perhaps they might be willing to pay to get that back.  I once had a doctor tell me their cyber security posture was "stay small and they won't think I have any money".  While it IS a strategy, it's not one that I would endorse.

To read the article on bankinfosecurity, follow this link.  

There is also a really great article on the DPR website that was written by my good buddy Brett Callow and his friend Meredith Griffanti.  They are both experts in cyber security and were awesome about writing this article on "Protect Your Dental Practice from Ransomware".  These 2 are well known and established experts in the field of cyber security, so if you are a dental professional, be sure to follow the link and read this article.  

Wednesday, November 30, 2022

AMD Lasers has Special Pricing During Cyber Week!


Over the years I've worked with AMD Lasers quite a bit, both with the products and the company.  I've found their products to be reliable and best of all... affordable.  As anyone in dentistry  will tell you, the cost of equipment can be a serious impediment to adoption.  The good thing is that companies like AMD exist that produce quality equipment while also making that equipment affordable.

I've been using lasers in my practice since the late 1990s and I can tell you from personal experience that they give me a tremendous advantage in what I do.  There are a lot of things that lasers allow you to do and I use them almost every day.

So it's great to be able to tell you that AMD is having a tremendous sale this week.  As you can see from the graphic above, their Picasso diode lasers are 50% off and the Monet handheld curing laser is 30% off.

If you are interested in exploring what a laser can do for you as far as soft tissue surgery or high speed curing, head on over to the AMD website and take advantage of the discounts they are offering this week.  

Tuesday, November 29, 2022

Tech Titan Mark Cuban Working Toward Helping Hospitals to Eliminate Drug Shortages

Most folks, whether you are in healthcare or not, are well aware of all kinds of supply chain issues that were caused by all of the shutdowns during the stop the spread part in the early days of the pandemic.  It's been amazing to see what things are and what are NOT readily available since then.  The automobile industry has been especially hard hit as they depend on *lots* of parts from many, many companies.  Getting things back on track since 2020 is *still* a challenge.

 As most of us in healthcare know, since the whole Covid-19 supply chain problem began to rear its ugly head, there have been shortages of different drugs at different times.  Obviously shortages of medications can be hugely impactful for patients that require certain medications to stay healthy or stay alive.  If you've ever wondered what drugs are impacted by shortages, the FDA has a website that you can consult to find out.  That FDA page also has a link to the Google Play Store and the Apple App Store where you can download mobile apps that will also give you the info.

Needless to say, the solution needs to be uncovered because drug shortages can have serious consequences.  That's why I was happy to come across some info regarding tech entrepreneur Mark Cuban, putting his efforts behind a way to help solve this problem.  He has created the Mark Cuban Cost Plus Drug Company.  The idea is that the company will produce low-cost versions of costly generic drugs.  He has also said the company plans to "provide radical transparency in how we price our drugs."

It seems that in February 2022, the company began construction on an $11 million facility in Dallas to manufacture some of those drugs.  The plant is said to be due to open early in 2023.  

If you are interested in more info on this project, Mr. Cuban recently discussed the concept on a podcast popular with investors.  You can listen to the podcast by following this link...  

Monday, November 28, 2022

General Motor OnStar Partners with NORAD to Track Santa


I will have more info on NORAD Tracks Santa as Christmas Eve approaches, but since today is really the beginning of the Christmas Season I thought I would make today's post about. OnStar's partnership in that endeavour.

Most of us have a preferred car company and for some reason, mine has been Chevrolet.  I have no idea why, but I have a loyalty to the brand.  So I was excited to learn that the General Motors OnStar program has had a long standing partnership with NORAD.

The North American Aerospace Defense Command (NORAD) tracks Santa every Christmas Eve; and as I said earlier, I'll post more on that program on December 23rd... before Christmas Eve.  However, the important takeaway from today's post is that since 2009 General Motors OnStar has been teaming up with NORAD to help in that tracking.

By pushing the blue OnStar button in your vehicle on Christmas Eve, you'll be connected with an OnStar Advisor that can provide you and your child a location of Santa as he journeys around the globe.  In case a child is concerned Santa won't be able to find them, the OnStar Advisor can assure them that the big guy will indeed be on his way!

The service will run from 6 a.m. EST Christmas Eve to 5 a.m. EST Christmas Day.  Also, every time someone pushes the button during those times, GM will donate $1 to the Canadian Red Cross (up to $3000).

A big Thank You to OnStar as well as the great folks at NORAD!

Wednesday, November 23, 2022

Timeout for Thanksgiving!

 The Thanksgiving holiday is upon us here in the U.S. so I won't be posting again until next week.

With the idea of "thanksgiving" in mind for the next few days, I'd like to share a story with you and i hope it puts things into perspective...

When I was a little boy I would occasionally have one of those "kid meltdowns" that all parents are familiar with.  Now not all of these occurred around my mom & dad.  My grandmother used to let me come stay with her on a regular basis and sometimes I'd have one of those moments while I was in her care.  During those moments, my grandma was prone to say, "oh just count your blessings..."

We all have a lot to be thankful for.  Lately I've been talking to patients about the term "first world problems" and when I talk about that, I think of my grandmother.  Somewhere she is smiling knowing that I finally figured out that waiting an  extra 60 seconds for an 8 dollar latte isn't really a problem at all.  There are people out there waking miles to find clean drinking water for their children and I can just turn on the faucet.

I still get frustrated sometimes, but I have learned my "first world problems" aren't really problems at all.  I think we all need to "count your blessings".  Thanks, Grandma.  I miss you!

Tuesday, November 22, 2022

FDA says Naloxone (Narcan) is Likely Safe for OTC Availability

 For those of you who are not healthcare providers, you may not be familiar with the drug Naloxone (also known as Narcan).  The medication is an incredibly fast acting reversal agent for narcotics.  Basically if a person is suffering from an overdose, administering Narcan can completely reverse the overdose situation and bring a patient back from a potentially fatal situation.  

The drug was developed in the early part of the 1960s by Jack Fishman who was a researcher at Sloan-Kettering Institute for Cancer Research.  However, he developed Naloxone while working part time at Endo Laboratories Narcotics Division.  When initially synthesized,  no one saw much use for the drug.   

Fast forward to today and Naloxone has become a major life saver.  It is carried by most police officers who answer emergency calls as well as EMTs.  It works *amazingly fast* and can, in some instances, mean the difference between life and death for an individual.

In my office we have 2 nasal spray units in our emergency medical kit.  These are small unidose dispensers that allow us to insert it into the nasal opening of a patient and then shoot a fine spray of the drug into the nasal passages where it is rapidly absorbed through the sinus lining and quickly delivered into the bloodstream.  These are the same dispensing units that are frequently carried by the first responders.

The FDA is giving consideration to the 4mg nasal spray units as well as the 2 milligram dose that can be given through an auto injector, which is similar to the "epi-pen" many people are familiar with.  Naloxone has a high degree of safety and would be easy to use in these delivery options.

If approved, this decision would have a tremendous opportunity to save lives.

You can read the FDA information on this subject by following this link.  

Monday, November 21, 2022

Amazon Clinic is Coming as The Everything Store Pushes into Healthcare


An interesting move in the telehealth space has been announced recently.  Amazon, which is the world's largest online retailer, has announced Amazon Clinic.

The system will operate in 32 states when it starts.  The idea is to provide "virtual care" for 20 common health conditions such as allergies, acne, and hair loss.  It will be a message based virtual telehealth service that will strive to connect doctors with patients in way that is more convenient for patients and more efficient for doctors.

The basic idea is 

  1. The patient selects the condition they need help with
  2. The patient selects a provider from a list
  3. The patient completes a short intake form questionnaire
  4. The patient is then connected to the provider through a secure message-based portal

While I am a firm believer in the doctor patient relationship, I also realize that many folks need an affordable healthcare option that is available when *they* are.  There are also folks who lack transportation or are in rural areas where a trip to the doctor could require a lengthy amount of travel.  Let's face it, as a doctor of the head and neck, I see certain situations where I could do some remote diagnosis and triage.  There are times when a doctor doesn't absolutely need to "touch" the patient to make an accurate diagnosis.  Now, the flip side is that there ARE times that a physical visit is *absolutely* necessary.  However, if it isn't needed, why make people jump through unnecessary hoops?

My personal feelings are that this is filling a definite need.  There are some "holes" in the U.S. healthcare system and filling those holes is necessary and a *good* thing.  We are seeing rapid expansion in telehealth by many companies currently.  Almost everyone has an Amazon account and if utilizing this service can help some people.  My thoughts are, let's get help to those people.

Thursday, November 17, 2022

CMS Warns their Medicare Users about Deceptive Marketing...

 I *love* a free press!  There are times when the truth has to get out.  According to the Associated Press:

With Medicare’s open enrollment underway through Dec. 7, health experts are warning older adults about an uptick in misleading marketing tactics that might lead some to sign up for Medicare Advantage plans that do not cover their regular doctors or prescriptions and drive up out-of-pocket costs.

I'd like to say this kind of behavior stuns me... but this kind of behavior does NOT stun me.  Taking advantage of older people has probably existed as long as there have been... people.   The troubling part of this is they are trying to take advantage of folks who aren't as mentally sharp as they were in their youth, have less money to spend, AND will need medical services.

Allowing money grubbing crooks to cheat those folks goes against everything we stand for as a nation.

Of course marketing is always trying to convince us to part with our money, but doing so in such an ethical manner is just wrong.  The good news is the CMS (Centers for Medicare and Medicaid Services) is making a concerted effort to stop this practice.  They've started actually using some of their employees as "secret shoppers" to try and find out who is offering these less than honest plans and then shutting them down.

I salute the AP for bringing this to light and I also salute CMS for trying to rein in these unethical people.  The whole story from the AP can be found by following this link.  

Wednesday, November 16, 2022

FDA Head Dr. Robert M. Califf Takes Stand on Twitter Membership

 The fact that Elon Musk now owns Twitter has been a cause of much consternation and concern about what direction Twitter will head in as well as what the future holds for that social network.  While a lot of the concerns seem to be political... many are not.  I try not to enter into political discussions online as I don't reel that is my place.  So with that being said, I *do* think some situations on Twitter bear discussing here...

I was very impressed when I read lately of the decision of Dr. Robert Califf, who head the FDA.  His statement, that was placed on Twitter, reads:

 "The easy thing to do would be to abandon using Twitter, but that’s not the right thing for us to do at this time. More than ever before, it’s important that FDA continues to use Twitter for good and do everything in our power to protect the public from potential harm."

I have to say that I agree with Dr. Califf.  Even though he is a political appointee, I don't feel that statement is political.  Basically his point is that if knowledgeable people leave the platform, than who is there to provide knowledge in that particular subject.

The entire thread of the thought is impressive in my opinion.  You can read the thread by following this link.  I feel the world could use some more calm opinions like this.

Tuesday, November 15, 2022

School of Dentistry-Led Team Takes Novel Approach to Treating Jaw Osteonecrosis

 Here is some potentially good news on a dental discovery which may lead to a cure for the dreaded disease BRONJ.  It seems that a team of very bright folks from the UCLA School of Dentistry have discovered a topically applied medicament that can allow these lesions to heal uneventfully.  

Last week I posted some new info from the AAMOS regarding this disease, and now we have some potentially groundbreaking news from UCLA.

Here is a portion of the article:

A team of scientists led by the UCLA School of Dentistry’s Ichiro Nishimura, D.D.S., D.M.Sc., D.M.D., has discovered a promising treatment to prevent or alleviate bisphosphonate-related osteonecrosis of the jaw (BRONJ) through a newly formulated topical medication. 

 The findings published in an open-access research article in eLife demonstrated how BRONJ – visible as a morbid jawbone lesion – was rapidly closed and chronic gingival inflammation resolved in mice. Based on these promising results, in conjunction with UCLA’s Clinical and Translational Science Institute (CTSI) Nishimura has submitted an application to the FDA requesting information for human trials.

 BRONJ is a rare but severe side effect seen in those who have been prescribed bisphosphonates to slow bone loss, either for bone cancer or more frequently, osteoporosis; those suffering from the latter is condition won a well-publicized 2008 class-action lawsuit against drug maker Merck. In turn, bisphosphonate prescriptions have declined over the past 15 years due to apprehension among patients and healthcare providers, correlating with a rise in bone fractures.

“BRONJ was a previously-unknown disease with persistent and painful jawbone necrosis without any available treatments; the only commonality among these patients was a history of anti-resorptive drug treatment such as bisphosphonates,” said Nishimura. “In 2006, our team at UCLA’s Weintraub Center for Reconstructive Biotechnology hosted a retreat with scientists and clinicians determined to solve this mysterious disease.”

To read the article in its entirety, follow this link.   

Monday, November 14, 2022

Learn Composite Dentistry at the Center for Esthetic Excellence in Chicago

 Announcing the 2023 Continuing Education Lectures and Hands-on Workshops 

The Center for Esthetic Excellence, (CEE) has scheduled a lecture and hands-on workshop, entitled, “Direct Resin in the Anterior Dentition: Approaching the Complex Case,” 

Thursday – Friday, January 19-20, 2023, 8:00 a.m. – 5:00 p.m., presented by Dr. Jason Smithson.

Treat a discolored lateral, a peg lateral, a Class IV and close a diastema all in one arch.

Approach and create a treatment plan with direct resin, using a combination of opaquers, tints and advanced matrixing techniques. Dr. Smithson will carry out each exercise in a stage-by-stage fashion. For more information regarding this course, please contact Erika Heier at 800-837-2321 or

Thursday, November 10, 2022

Sophisticated Attempt of Data Theft - Why You *Have* to Remain Vigilant

 I had an interesting experience last week that I'd like to tell you all about since it could potentially happen to you as well... The good thing is that my installed security stopped the potential problem, but I should have caught it myself.

Since we run a pretty busy practice, we order a lot of supplies.  Every day our UPS driver brings in several boxes.  We have all of our ordering pass through one employee to help us keep a handle on things, but I also order supplies on occasion for specific uses that I am better equipped to know.

Last week I had personally ordered 3 different things all coming in different shipments.  I wasn't sure how the orders would arrive.  We routinely receive things from UPS, FedEx, DHL, and the United States Postal Service.

On Thursday I was sitting at my desk when I received a text message on my mobile phone.  It came from a long distance number that was not in my contacts.  While that alone, would normally raise my suspicions, the message itself helped decrease those concerns.  The message read:

[US-PS]: We cannot deliver your package to you due to incorrect house number. Fill in the correct address online and we will redeliver

The message ended with a link to a website.  The message being from "US-PS" should have made me more cautious, but I thought "the postal service probably uses this all of the time."

I opened the link on my Mac and a webpage opened.  The address was to "" and there were all kinds of blank fields for me to fill out.

Fortunately I had used the US Postal Service website before and I knew their address was "" with NO hyphen.   The suspicious website had a tracking number for my package with a lot of fields  for me to fill in.  Before I clicked anything on the page or input any data, I opened another tab and went to the USPS website where I went to the package tracking page and input the number on the suspicious page.  The search came back with "no package found".

I returned to the suspicious tab and when I looked at it, by now a couple of my security programs popped up warning me that this page looked suspicious and NOT to enter any data or click any links.

Had I been busier or in desperate need of some supply I was expecting, I might very well have filled out the page and submitted the info BEFORE my security apps had caught it.   Fortunately my suspicions paid off and saved me, but I almost committed the cardinal sin of entering or clicking without a second thought.

It's a bit disconcerting knowing that my mobile number is out there in a database for scammers to use, but that is the price of being so connected, I suppose.  However, I wanted to make all of you aware of this situation in case something similar happens to you.

Wednesday, November 9, 2022

Living Security Partners with SpyCloud to More Effectively Identify Enterprise Human Risk

Two Austin-based cyber companies partner to mitigate the effects of security hygiene on enterprise risk

AUSTIN, TX - Nov. 9, 2022 - Living Security, the leader in Human Risk Management, today announced a partnership with SpyCloud, the leader in Cybercrime Analytics, to better identify segments of human risk inside organizations and help security leaders create a proactive plan to mitigate attacks.

Living Security’s Unify Human Risk Management Platform now includes SpyCloud’s Identity Risk Engine, which delivers risk assessments and key risk indicators (KRIs) based on analysis of 300+ billion assets recaptured from data breaches and malware victim logs being traded in the criminal underground. The KRIs link email addresses, usernames, passwords, and PII across employees’ exposed online personas, giving security teams a fuller picture of individuals’ security hygiene, as well as details on the scope, recency, and severity of their darknet exposures. Through this partnership, organizations will be able to better identify the most vulnerable segments within their workforce, including employees with compromised accounts and credentials, so they can best mitigate the human risk exposure and measure their behavior over time.

Eighty-two percent of breaches currently involve the human element. “What is killing organizations is the daily human failures, not the big, notable incidents. These smaller missteps are happening millions of times a day and if you want to lower the onerous demand on your security team, you need to focus on human risk management,” said Dan Walsh, CISO of VillageMD and a member of Living Security’s CISO Advisory Board.

To date, clients using Living Security’s Unify Human Risk Management platform have been able to see their riskiest segments from an “inside-out” view using the internal data from their technology stack, and now they are also able to get the “outside-in” perspective leveraging SpyCloud to decrease risk for their organizations.

“Our focus at Living Security has always been on the human factor. We are disrupting the industry and driving a paradigm shift that enables organizations to leverage behavioral data to effectively manage and mitigate human cybersecurity risk,” said Ashley Rose, CEO and co-founder of Living Security. “This partnership with SpyCloud is an incredible step in this mission, allowing us to access real-time darknet exposure insights that matter to our clients – identifying employees with riskier behaviors and alerting us to those whose credentials and personal data are compromised. This gives our clients the information they need to prioritize the riskiest segments using a data-led approach to keeping their organizations safe.”

“At SpyCloud, we’re continuously working to help businesses stay a step ahead of cybercriminals. Embedding proactive insights in Living Security’s platform helps security leaders understand, at-a-glance, the risk employees pose to the organization,” said Cassio Mello, Senior Vice President of Business Development at SpyCloud. “We share a joint belief with Living Security that staying secure from ransomware, breaches, and account takeover requires taking action on the exposure of individuals in your workforce.”

The partnership comes on the heels of the release of a new Human Risk Management Maturity Model that Living Security is pioneering with other industry leaders to set a new standard of measuring the human risk exposure for organizations. To learn more, visit

About Living Security

Living Security’s mission is to transform human risk to drive dramatic improvement in human behaviors, organizational security culture, and infosec program effectiveness. With our Human Risk Management platform, Living Security engages each employee with innovative and relevant context and content, while simultaneously providing the ability for leadership to identify, report on and directly mitigate the risk brought on by human behavior. Living Security is trusted by security-minded organizations like MasterCard, Verizon, MassMutual, Biogen, AmerisourceBergen, Hewlett Packard, and Target. Learn more at

About SpyCloud

SpyCloud transforms recaptured darknet data to protect businesses from cyberattacks. Its products operationalize Cybercrime Analytics (C2A) to produce actionable insights that allow enterprises to proactively prevent ransomware and account takeover, protect their business from consumer fraud losses, and investigate cybercrime incidents. Its unique data from breaches, malware-infected devices, and other underground sources also powers many popular dark web monitoring and identity theft protection offerings. SpyCloud customers include half of the ten largest global enterprises, mid-size companies, and government agencies around the world. Headquartered in Austin, TX, SpyCloud is home to nearly 200 cybersecurity experts whose mission is to make the internet a safer place. 

To learn more and see insights on your company’s exposed data, visit

Tuesday, November 8, 2022

Outbreaks of Nontuberculous Mycobacteria Infections Highlight Importance of Maintaining and Monitoring Dental Waterlines

 Here is the latest on Dental Unit Waterlines from the CDC...


The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to emphasize the importance of following existing recommendations for maintaining and monitoring dental waterlines. Multiple outbreaks of nontuberculous Mycobacteria (NTM) infections have occurred in children who received pulpotomies in pediatric dental clinics where the dental treatment water contained high levels of bacteria. CDC provides guidelines on infection control in dental settings which contain recommendations to treat dental unit waterlines and monitor water quality. Dental providers should be familiar with these recommendations on how to properly maintain and monitor their dental equipment to ensure that dental treatment water is safe for patient care.


While rare, there have been multiple documented cases of disease transmission from dental unit waterlines (narrow-bore plastic tubing that carry water to the high-speed handpiece, air/water syringe, and ultrasonic scaler).1-5 Dental units have unique characteristics that make them prone to biofilm formation.6 Biofilms occur in dental unit waterlines due to the long, small-diameter tubing and low flow rates used in dentistry and the frequent periods of stagnation. As a result, high numbers of common waterborne bacteria can be found in untreated dental unit water systems. Disease-causing microorganisms found in untreated dental unit water can include Legionella, Pseudomonas aeruginosa, and nontuberculous Mycobacteria (NTM).

Dental providers and patients could be placed at risk of adverse health effects if dental unit water is not appropriately treated. In March 2022, CDC was notified of a new cluster of suspected NTM infections in children following dental procedures at a pediatric dental clinic. Investigation into this cluster is currently ongoing, and preliminary site visit data report that dental unit waterline testing results showed microbial counts much higher than the level recommended by CDC.

In 2016, an outbreak occurred at a pediatric dental clinic in Orange County, California, with 71 patients identified as having odontogenic NTM infections following pulpotomy procedures.1 Municipal water stored in a pressurized bladder holding tank was used to fill the dental unit water bottles. The clinic was not using disinfectants on their dental unit waterlines or regularly monitoring water quality. All water samples tested from the dental units showed microbial counts higher than the level recommended by CDC and multiple species of NTM were identified in syringe water samples from five of the six treatment rooms.

In 2015, 24 cases of odontogenic NTM infections were reported in children receiving pulpotomy treatment from a pediatric dental clinic in Georgia.2 Investigators from the Georgia Department of Public Health found that municipal water was used during dental procedures, the clinic was not using a disinfectant in their dental unit waterlines, and the clinic was not regularly monitoring the water quality as recommended by CDC. Microbial testing of the water samples taken from the dental units showed very high microbial counts of Mycobacterium abscessus. The M. abscessus isolates recovered from the water were found to be identical to eight isolates from tissue samples from seven of the patients, suggesting that water was the source of the infections.

The outbreaks in California and Georgia involved young children, with ages ranging from 4 to 8 years. Many of the children developed severe infections with clinical diagnoses such as cervical lymphadenitis and mandibular or maxillary osteomyelitis, and required hospitalization, treatments such as intravenous antibiotics, and surgical procedures. Complications from their infections included permanent tooth loss, hearing loss, facial nerve palsy, and incision fibrosis.

Because of the potential to form biofilm, CDC recommends that all dental unit waterlines be treated regularly with disinfectants to meet the Environmental Protection Agency (EPA) regulatory standards for drinking water (i.e., ≤500 colony forming units (CFU)/mL of heterotrophic water bacteria).7 There are many commercial products and devices available to disinfect and maintain dental unit waterlines. Dental unit water quality must also be monitored routinely as recommended by the equipment manufacturer to ensure that treatments are working effectively and that the water used in dental procedures meets safety standards.6 Dental providers should consult with the dental equipment manufacturer for appropriate methods and equipment to both maintain and monitor the quality of dental water.

Oral surgical procedures involve the incision, excision, or reflection of tissue that exposes the normally sterile areas of the oral cavity. Examples include biopsy, periodontal surgery, apical surgery, implant surgery, and surgical extractions of teeth (e.g., removal of erupted or nonerupted tooth requiring elevation of mucoperiosteal flap, removal of bone or section of tooth, and suturing if needed). During oral surgical procedures, dental practitioners should use only sterile solutions as a coolant or irrigant using an appropriate delivery device, such as a sterile bulb syringe, sterile tubing that bypasses dental unit waterlines, or sterile single-use devices.

For the full post with recommendations & resources, follow this link

Thursday, November 3, 2022

AAMOS Surgical Experts Publish Updated MRONJ Guidance

 On occasion, the best efforts of our medical system can actually solve one problem and unintentionally create another.  One of these situations is a troubling outcome from bisphosphonate therapy.  What follows is the most recent information from AAMOS...

AAOMS prioritizes prevention of the jaw disease, continuing cancer care

The American Association of Oral and Maxillofacial Surgeons (AAOMS) has issued updated guidance for treating a rare but potentially serious jawbone condition that can impact patients taking antiresorptive medications to treat certain cancer types.

Medication-related osteonecrosis of the jaw, or MRONJ, is often-painful and characterized by exposed dying bone in the upper and lower jaws, swelling of the gums and loosening of previously stable teeth.

To help patients and healthcare providers navigate this clinical concern, oral and maxillofacial surgery experts analyzed literature and revised guidance to reflect current best practices. The 2022 recommendations – published in the Journal of Oral and Maxillofacial Surgery – prioritize preventing the disease while continuing cancer treatment necessary to maintain quality of life and support bone health.

"Although no individual nor collection of strategies eliminates all MRONJ risk, certain preventive procedures can make a difference," said lead author Salvatore L. Ruggiero, DMD, MD, a practicing surgeon and professor at the Stony Brook School of Dental Medicine in New York. "Maximizing overall patient well-being is always the preference."

Among strategies for reducing the risk of MRONJ: maintaining good oral hygiene, performing high-risk surgical procedures prior to initiating drug therapies, quitting smoking and optimizing diabetes care.

Authors agree that prevention starts with realizing that patients receiving bone-preserving medications (antiresorptives) face altered wound-healing capacity, another potential risk factor for developing MRONJ. Healthcare providers must recognize the importance of coordinating dental care and treatment planning for osteoporosis and cancers involving these therapies, they wrote.

Doing so requires continuous efforts to educate patients, dentists and medical professionals about the real risks associated with antiresorptives and the clinical paradigm shift needed to mitigate MRONJ, researchers wrote.

AAOMS emphasizes the importance of a multidisciplinary approach to treating patients receiving such treatment. This also may apply to other substances used to stimulate the immune system or targeted therapies taken alone or in combination with antiresorptives (brand names such as Fosamax, Boniva and Prolia). Team-based MRONJ care includes consulting an appropriate dental professional when a doctor determines a patient could benefit from these medications.

"Oral and maxillofacial surgeons are versed in treating this clinical concern, and it is crucial that oncologists, rheumatologists and other providers work with our specialty to prevent and treat it," said Thomas B. Dodson, DMD, MPH, article co-author and editor-in-chief of the Journal of Oral and Maxillofacial Surgery, AAOMS's official journal. "Our goal in issuing this update is to educate both our peers in medicine and patients about the evolving knowledge base in addressing MRONJ."

It is important to understand that patients at risk for or with MRONJ also may present with other issues that appear similar, authors wrote. Commonly misdiagnosed conditions may include dry socket, sinusitis, gingivitis and periodontitis. Therefore, they said it is important for patients to undergo a detailed clinical and radiographic examination by an experienced oral healthcare practitioner to diagnose MRONJ.

There are several other local, potentially predisposing factors – including tooth extraction and operations on the thickened ridge of the bone that contains tooth sockets. Other concerns such as steroid and tobacco use may increase risk. The danger of developing MRONJ is higher in patients who have received antiresorptive medications for metastatic bone disease (less than 5 percent) compared to those receiving such drugs for osteoporosis (less than 0.05 percent).

Surgical management of MRONJ is increasingly considered a viable method of treatment for all stages of the disease, according to the 2022 guidance. These procedures involve the removal of necrotic jawbone until viable bone is encountered. AAOMS has developed a series of algorithms to assist doctors in streamlining and determining the correct care pathway for individual patients. A departure from the three previous position papers, the 2022 recommendations recognize the value of surgical intervention regardless of MRONJ disease stage.

AAOMS supports continued oncologic treatment for MRONJ patients whether they are receiving antiresorptive therapy alone or in combination with immune modulators or antiangiogenic medications. Authors wrote that quality of life is typically managed by preventing new areas of necrosis, controlling secondary infections, offering pain control and educating patients.

Additionally, the new guidance deemphasizes the role of medications other than antiresorptives in causing the condition. Studies suggest the cause is likely multifactorial, stemming both from drugs prescribed alongside inflammation or infection. A research review failed to prove if a drug holiday (ceasing use of medications for a defined period) is beneficial or harmful to patients, the authors wrote.

"Medication-Related Osteonecrosis of the Jaw – 2022 Update" was developed by three authors of the 2014 AAOMS position paper on MRONJ, along with three member of the Association's Committee on Oral, Head, and Neck Oncologic and Reconstructive Surgery. In addition to Drs. Ruggiero and Dodson, authors include Tara Aghaloo, DDS, MD, PhD, UCLA School of Dentistry; Eric R. Carlson, DMD, MD, EdM, University of Tennessee Graduate School of Medicine; Deepak Kademani, DMD, MD, North Memorial Health and the University of Minnesota; and Brent B. Ward, DDS, MD, University of Michigan Hospital.

At an MRONJ presentation during AAOMS's 104th Annual Meeting, Scientific Sessions and Exhibition in New Orleans in September, Carlson told attendees the update was needed to reflect numerous advancements in MRONJ knowledge over the past eight years.

"It became very clear to our national organization that there were many substantial and very interesting changes in terms of our understanding of this disease, particularly with regard to its treatment," he said.

Carlson said the updated definition of an MRONJ case includes three elements:

Current or previous treatment with antiresorptive therapy alone or in combination with immune modulators or antiangiogenic medications.

Exposed bone or bone that can be probed in the maxillofacial region that has persisted for more than eight weeks.

No history of radiation therapy to the jaws or obvious metastatic disease to the jaws.

"MRONJ is preventable, resectable and reconstructable in a very predictable fashion," said Carlson. "The new position paper will help medical and dental professionals in their treatment of patients who require these medications." 

Read the full position paper at

Wednesday, November 2, 2022

Apple Announces that iPhones are Switching to USB-C

  Apple has always been a bit of a "lone wolf" when it comes to hardware.  The company maintains tight control over their hardware and software empire.  In some ways this can be an incredibly good thing.  You don't often buy or hear of an Apple product that has hardware issues or compatibility issues with another piece of Apple hardware.

However, like the Yin and Yang, there are positives and negatives to everything.  Sometimes that means Apple forces its users into hardware formats they may not want to go.  As an example, I'll use my current MacBook Pro.  I purchased it shortly before Covid hit in 2019.  At the time, that model only offered 4 ports and there were *all* USB-C.  Even the power port was USB-C which forced me to use one of the 4 ports just to charge the device.  My previous model had several different ports including HDMI, USB, and even an SD card slot.  My new Mac forced me to buy all kinds of dongles and adapters so that I could connect to an Ethernet cable, HDMI , SD, USB 2.0, and even a second HDMI adapter as I usually am working from 3 screens.

Imagine my frustration when recently the company announced that their new MacBook Pro models would offer a variety of ports to meet consumer demand.  I was *less than thrilled*.

And that brings us to the point of today's post.  In an effort to make things easier for consumers, the European Union placed a mandate on manufacturers to use USB-C to charge their devices.  In the last, probably 7 years (although I'm not sure of the exact amount of time), Apple has used their proprietary "Lightning" connector to charge iPhones, iPads, and iPods.  

Personally I'm grateful to the EU for this little piece of legislation.  I'm tired of having to have a lighting cord with me whenever I want to charge my phone or tablet.  The mandate is set to take affect in autumn of 2024, but Apple is not hiding their angst over it.

For a full discussion, take a look at this page from The Verge...  

Tuesday, November 1, 2022

FDA Announces Shortages on Amoxicillin Suspensions

 A short post today as most of us are probably a bit tired after the big Halloween Celebrations from last night.

I saw this list on the FDA website and found it of interest.  It seems there is a shortage of amoxicillin currently, but only on the suspensions (liquids).

This would mainly affect children and patients who are unable to swallow pills.  Obviously that is a smaller subset of patients, but if it affects you (as a patient) or you (as a prescriber) either situation can create complications.

The good news is that this shortage is supposed to be short lived with the experts expecting things to return to normal in early November.

If you have questions or want more information, here is a link to the FDA website that deals with the shortage.   

Also, if you would ever like to check on information like this, the FDA has a searchable database of Current and Resolved Drug Shortages and Discontinuations Reported to FDA.  

Monday, October 31, 2022

New Data Wiping Program Attempts to Blame/Frame Honest Security Researchers

While I wish I could tell you that today's post is a Halloween joke, that simply is not the truth.  The cyber world is frequently an unsafe place, and this is another instance of that...

Here is an interesting story that, at least at this point, does not have a large number of victims, but is fascinating in its deployment.

As many in the tech world know, Putin and the Russian security services have tremendous reach in the cyber realm.  There are instances such as the 2016 US election interference, data crashing worms, the takedown of the IT systems of the Seoul Olympics, and multiple attacks on the Ukrainian power grid prior to the 2022 invasion.

Now comes an attack that attempts to blame/frame security researchers and a computer website for a new destructive program.  Called Azov, it masquerades as RansomWare, when in fact its sole purpose is to totally encrypt hard drives with no way to decrypt.

It leaves a ransom note that reads:

When the victim reads this ransom note, they see a list of potential criminal partners near the top.  All of those listed have denied an knowledge or involvement with this situation.  Also, if you read the entire note it seems to be pointing to a pro-Russia approach to the invasion of Ukraine.

If possible, do not allow Azov onto your systems and if you are one of the unfortunate individuals affected by this, hopefully you have reliable backups as there is NO decryption key.

For the full story, you can follow this link to  

Thursday, October 27, 2022

Amber Mill DIRECT and Perfit FS Now Undergoing Testing in our Office

For those of you who either have a mill in your office or are considering getting one (and if you aren't, NOW is the time to be looking into it), I have some interesting news.

For a lot of offices, they don't want to necessarily transfer ALL of their lab functions in-house.  What many offices are looking for is materials that can be polished to a finish instead of needing to stain and glaze using an oven.

However, along with that aspect, there is also the aspect of wanting certain materials that *require* firing in an oven.  Many offices would love to have the aesthetics of lithium disilicate or the strength of zirconia.  However, as we know lithium disilicate in its original state is lavender in color until it is fired.  Then there is zirconia which needs to be fired to shrink to the exact size needed to fit the prep.  If zirconia is *not* fired, the material will not fit.

Well, now those two concerns are no longer valid.  Amber Mill DIRECT is a lithium disilicate that is the correct shade when milled and can be polished to a high level.  Next up is Perfit FS which is a zirconia sintered block that does not require an over either.

Basically this means that offices wanting to do in-office milling can do so while getting the matterials they want with the convenience they need.

I've been fortunate enough to receive some samples of both materials and I will be milling some cases with them in the not too distant future.  Once we get some cases under our collective belts, I'll be posting more about how they perform.  I got a chance to see some of these milled restorations at the recently held SmileCon in Houston and in the DGShape booth, they looked amazing.  However, I'm a skeptic by nature and will withhold judgement until I work with the materials myself.

In the meantime though, here is a photo of a Perfit FS that I saw in Houston.  I'll be reporting back when I have more to say on these materials...

Wednesday, October 26, 2022

Cutting the Cord... and Costs With a New Approach to Gingival Retraction


Here's a little something I put together after experimenting with VOCO's Retraction Paste.  As most of you know I'm always looking for ways to increase efficiency.  No one wants a dental procedure to take longer.  So when i see an opportunity to increase my efficiency, I explore it.  I've found one of those great little ways to increase efficiency is with this product.  Read on for my thoughts...

Fixed prosthetics are an intrinsic part of any dental practice. While the market for dental implants continues to grow, the majority of crowns are placed on natural teeth. This means that clear and easily recognizable margins are necessary and will continue to be necessary as the market for naturally supported dental fixed prosthetics continues to grow. As life expectancies continue to increase, an aging population will seek to maintain their quality of life and the number of fixed prosthetic procedures will increase along with those life expectancies.

There has also been growth in the last decade in the purchase and implementation of digital impression systems. These systems continue to experience market penetration growth with estimates being that around 20% or more of practices have expanded into this aspect.

However, whether performed by analog or digital means, the importance of good clinical technique is imperative for clinical success in fixed prosthodontics. This is especially true when consideration is made for the proper capture of the preparation margin. While many aspects of the preparation are intrinsic to long-term clinical success, perhaps nothing is more important than properly capturing the margin.


Traditionally the most common way to expose the margin for an impression has been the use of retraction cord. Even though the profession has evolved and improved, retraction cord has continued to be taught in dental schools and used in the majority of clinical cases, even though other choices exist.

Retraction cord is time consuming. A proper length of cord must be dispensed and then placed into the gingival sulcus to allow the tissues to expand and relax in a more open orientation. The actual physical process of placing retraction cord is time consuming and incredibly technique-sensitive. Apply too little pressure in the placement and the cord comes free without providing adequate retraction. Apply too much pressure and the connective tissues of the sulcus can be damaged and pushed away from the tooth, paving the way for gingival recession or iatrogenic infection. There are even instances of impression material being expressed subgingivally, creating foreign body infections from a hardened piece of material left under the tissues that were separated by over-aggressive retraction cord placement.

In some instances, a two-cord technique is used that basically doubles the amount of time to place, while also increasing the chances for cord displacement or iatrogenic injury.

There is also the concern of being able to visually identify the cord in the sulcus. Stories abound in the profession of patients presenting with a localized infection of a single tooth recently prepared for a crown and the doctor finding a strand of retraction cord still wedged snugly into the gingival sulcus with a resulting foreign body reaction in full bloom around it. Someone simply missed the tiny piece of cord.

Placing cord is a very specific and intense skill, demanding exceptional dexterity. It is a difficult skill to teach, and many doctors prefer to place cord themselves as opposed to delegating the placement to an auxiliary. However, this ties the doctor to the procedure and does not allow for other processes (such as hygiene checks) to be completed, therefore slowing the entire office workflow.

There is also the consideration of effectiveness of cord in all cases. In patients with high salivary flow, the cord can be washed out of the sulcus and require the procedure to be repeated thus slowing the workflow even more.

Considering Costs

Not only are assurances of long-term success a motivator, cost savings can be as well. Often doctors consider the “hard costs” of impressions when attempting to analyze office costs without taking into consideration the “soft costs” of time, frustration and lack of optimized workflow.

Survey data from the American Dental Association tells us that the average dental practice prepares about 360 crowns per year, which translates to 30 crowns per month. Factor into the equation that dental office overhead is roughly $5.00 per minute and it is easy to see that “soft costs” of time and optimized workflow mentioned above come into play in a very real way. If 5 minutes is spent in properly placing a single piece of retraction cord, that translates to around $25 just to cover the cost of placing the cord.

Improving Efficiencies and Workflow

One of the things successful doctors embrace is the concept of “just because we’ve always done it that way doesn’t mean we have to always do it that way”. There is no better example of this than achieving successful retraction in fixed prosthetics.

VOCO has developed a Retraction Paste that offers several advantages over the traditional placement of retraction cord.

First of all, the material is a paste, which means that expressing it into the sulcus is significantly less traumatic than pushing cord into place with a stainless steel instrument. The paste is provided in small capsules that hold 0.3 g of material, which is enough for approximately 3 single units. It is expressed from the cartridge via a traditional composite dispenser gun.

The compule has an extra-long tip with a very small diameter that allows the operator to place the tip into the sulcus and express the paste gently so that it provides consistent and atraumatic placement of the material. The lumen of the tip is carefully formed out of plastic with rounded edges so that it can be placed into the sulcus without the risk of traumatic injury to the soft tissue.

The paste contains aluminum chloride, which chemically dries the sulcus of blood, saliva, and crevicular fluid while also widening the sulcus. It has a two-phase consistency for ease of use. When first expressed from the cartridge, the paste is of low viscosity. This allows the material to be gently expressed and delivered precisely into the sulcus. Once placed, it changes to a higher viscosity and expands slightly to allow for adequate displacement and expansion of the tissues.

Once the paste is expressed into the sulcus, it remains there for 1-2 minutes and is then rinsed away with water. The material is easily removed by air/water spray and its unique bright turquoise color helps to assure the operator that all remnants have been removed prior to impressing.

Better Direct Restorations

Often in Class V restorations, there is either the need for retraction or drying. Many operators will notice that around 12 months post op, many buccal Class V restorations begin to develop a dark line around the gingival margin. This line is caused by less than ideal bond strengths in this area that allow for bacteria to begin to grow under the restoration. The most common cause of these “black lines” is contamination of the gingival margin with crevicular fluid.

This fluid is hard to stop mechanically as it tends to seep continuously despite the operator’s best efforts at control. Placing retraction paste is a great advantage in placing these restorations. The aluminum chloride in the paste is a tremendous drying agent and placing it prior to beginning the bonding process greatly helps in preventing contamination of the field.

It is also tremendously helpful for retraction during the restorative process. Doctors who use cord in these procedures are often faced with a dichotomy: Do you pull the cord prior to restoring or after? Sometimes the cord can aid in retraction by leaving it in place, however, there is also the risk of the cord becoming entangled in the restorative material which can lead to myriad problems. Using paste instead of traditional cord greatly simplifies this restorative process.


While retraction cord has served the profession well, it is imperative that doctors continue to explore procedural options that can help lead to better clinical outcomes.

VOCO’s retraction paste is one of those options. Whether the objective is analog or digital impressions or improving outcomes in indirect restorations. A paste that is easily dispensed, works quickly and predictably, and is removed easily offers the doctor options that are not routinely available with retraction cord.

Retraction paste can improve clinical workflows as well as providing for better and more predictable patient outcomes.