oralhygiene
www.oralhealthgroup.com
PM 4006317
September 2017
Strain & Pain IN THE DENTAL PROFESSION
Complete care for a healthier mouth The new Philips Sonicare DiamondClean Smart toothbrush Reduces gingival inflammation up to 70% better than Oral-B 7000 with CrossAction brush head1
Smart Sensor Technology Personalized coaching for better coverage, reduced scrubbing and ideal pressure via the Philips Sonicare app
Smart Brush Head Recognition Technology Automatically chooses the optimal mode and intensity level and monitors brush head lifetime
High Performance Brush Heads Up to: 10x better plaque removal,2 7x healthier gingiva2 and 5x more stain removal3
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Learn more about Philips Sonicare DiamondClean Smart at philips.ca/smart 1. In Deep Clean, non-connected modes using Premium Plaque Control brush head 2. vs. a manual toothbrush 3. vs. a manual toothbrush using a leading whitening toothpaste Phone not included. Š 2017 Koninklijke Philips N.V. (KPNV ). All rights reserved. PHILIPS and the Philips shield are trademarks of KPNV. SONICARE and the Sonicare logo are trademarks of KPNV and/or Philips Oral Healthcare, LLC.
oralhygiene CONTENTS
18
BOOK REVIEW
8
The Elite Practice Formula Carlo Biasucci, DDS
CLINICAL
10
8
Empowering Periodontal Therapy Sheri B. Dongier, DDS
HEALTH
18
30
Strain and Pain in the Dental Profession Gordon Levin, DMD, RYT
How to be Happier Now! Mindfulness and the Dental Professional
30
10
Gloria Alban, DDS, RHN
PRODUCT PROFILE
24
A New Generation of Fluoride Varnish is Coming to You! Sylvie Martel, RDH, DipDH, Teaching Certificate, NDHCB
An Alternative Practice Setting for One Canadian Dental Hygienist Started with a Simple Idea
34
Patricia Blundon
DEPARTMENTS Editorial
5
Dog Days
News
34
6
Chairside Guide Oral Cancers caused by HPV
Dental Marketplace
36 September May 2017
www.oralhealthgroup.com
3
One in four has it.
1
Many don’t know it.
2
They also may not know the oral health consequences.* They’re waiting for your guidance.
Dry Mouth is an oral health concern that affects people on multiple medications the most.3 Yet some people aren’t aware that it’s a problem.2 Talk to your patients about Dry Mouth and how Biotene can help provide relief.† ®
www.biotene.ca
GlaxoSmithKline Consumer Healthcare Inc., Mississauga, Ontario L5N 6L4 © 2017 GSK group of companies or its licensor. All rights reserved. * Dry mouth can disrupt the oral health environment and lead to halitosis, demineralization, and increased caries.4,5 † Mouthwash, Gel and Spray. ‡ As measured in a 28-day clinical study.6 1. GSK data on file. Biotène dry mouth growth opportunity (with Canadian U&A data). July 16, 2014. 2. Dawes C. How much saliva is enough for avoidance of xerostomia? Caries Res. 2004;38:236–240. 3. Sreebny LM, Schwartz SS. A reference guide to drugs and dry mouth, 2nd edition. Gerodontology. 1997;14:33–47. 4. Turner MD, Ship JA. Dry mouth and its effects on the oral health of elderly people. J Am Dent Assoc. 2007;138:15S–20S. 5. Fox PC. J Clin Dent. 2006;17(Spec Iss):27–28. 6. GSK data on file 2014, RH01986.
EDITORIAL
Dog Days These are the dog days of August as I write this and since we’ve barely had a summer I’m hard-pressed to write my Fall editorial. But it is time to try to get organized so let’s deal with odds and ends and bits and pieces…. Dentistry just got a little bit less invasive – and less painful. The FDA has approved a minimally invasive laser, a tiny laser fiber about the thickness of three human hairs, to treat gum disease by regenerating bone and tissue. It eliminates the traditional treatment of periodontal surgery, a highly invasive and often painful procedure. This less invasive technique means minimal post-operative discomfort requiring no opioid level prescriptions and faster recovery/healing time – most patients are able to drive themselves home and return to their regular daily activities immediately following the procedure. The LANAP protocol using the PerioLase MVP-7 was developed by Milllennium Dental Technologies and is the only laser-based gum disease treatment with the proven ability to regenerate all three periodontal tissues: alveolar bone, periodontal ligament and cementum lost to disease. More than 2200 dentists are now offering this preferred treatment to their patients. Most people avoid the dentist because of the fear of pain, but this new laser will change that. Over 80 percent of US adults suffer from some degree of gum disease and only 3% will accept treatment. Gum disease is linked to systemic diseases in-
cluding heart disease, Alzheimer’s, stroke, certain cancers, pre-term birth, diabetes and more. The procedure can be found by searching 'LANAP Protocol Laser Gum Disease Treatment' on YouTube.
Catherine Wilson Editor
********* Henry Schein says from September through December, it is offering its dental, animal health, and medical customers the opportunity to join the company in the fight against cancer. By purchasing a range of pink products, customers can help support the company’s Practice Pink program, an initiative designed to raise awareness and support a cure for breast cancer and other cancers. A portion of sales from these pink products – including health care consumables, practice supplies, and apparel – is donated to nonprofit organizations to support research, prevention efforts, and early detection of the disease, and to help improve access to care. Now in its 13th year, the Practice Pink program has raised more than $1.3 million for the fight against cancer through the Henry Schein Cares Foundation, a nonprofit organization that supports and promotes increased access to care globally. In 2016, the Practice Pink program expanded to Europe, where Team Schein Members across the continent teamed up with supplier partners and non-governmental organizations to positively impact the lives of people battling cancer.
September 2017 www.oralhealthgroup.com
5
NEWS BRIEFS
FDI Releases Chairside Guide for Dentists FDI World Dental Federation issued today a chairside guide to advise clinicians on restorative interventions with their patients. It was released on the opening day of the FDI World Dental Congress in Madrid, Spain (29 August-1 September) under the umbrella of the Caries Prevention Partnership (CPP), supported by Colgate. The guide is conceived as a visual support, with easyto-follow guidelines suitable for the dental practice. The goal is to reduce the impact of caries as early as possible, by preventing further tooth destruction and reversing the caries process in favor of remineralization, and ultimately empower the patient to improve and maintain their own oral health. The guide will provide greater understanding of lesion activity and guidance in determining caries risk according to varying risk factors throughout life. These universal risk factors - which consider socio-economic status, sugars consumption, poor oral hygiene, among others are classified in a context of five age groups: three covering children and adolescents, one adults, and one older adults. For each age group, there is a caries risk assessment, recommendations for professional maintenance, and suggestions for patient and education maintenance. Visit www.fdiworlddental.org for more information.
oralhygiene A NEWCOM Business Media Publication
Editorial Director: Catherine Wilson 416-510-6785 catherine@newcom.ca
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Cases of Oral Cancers Caused by HPV Rapidly Increasing The proportion of oral cancers caused by the human papillomavirus has risen significantly in Canada, say researchers, who suggest the infection is now behind an estimated three-quarters of all such malignancies. In a cross-Canada study published in the Canadian Medical Association Journal, the researchers found the incidence of HPV-related oropharyngeal cancers increased by about 50 per cent between 2000 and 2012. Researchers looked at data from specialized cancer centres in British Columbia, Alberta, Ontario and Nova Scotia to determine rates of HPV-related tumours among 3,643 patients aged 18 years or older who had been diagnosed with squamous cell oropharyngeal cancer between 2000 and 2012. Statistics from a Canadian Cancer Society report last fall showed 1,335 Canadians were diagnosed in 2012 with HPV-related oropharyngeal cancer and 372 died from the disease. To read the entire story, visit www.cbc.ca/news/health/ hpv-oral-cancer-canada.
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Oral Hygiene serves dental hygienists across Canada. The editorial environment speaks to hygienists as professionals, helping them build and develop clinical skills, master new products and technologies and increase their productivity and effectiveness as key members of the dental team. Articles focus on topics of interest to the hygienist, including education, communication, prevention and treatment modalities. Please address all submissions to: The Editor, Oral Hygiene, 80 Valleybrook Drive, Toronto, ON M3B 2S9.
Subscription rates: Canada $25.00/1 year; $47.00/2 years; USA $46.95/1 year; Foreign $46.95/1 year; Single copies Canada & USA $10.00, Foreign $18.00. GST/ HST #103862405RT0001.Printed in Canada. All rights reserved. The contents of this publication may not be reproduced either in part or in full without the written consent of the copyright owner. From time to time we make our subscription list available to select companies and organizations whose product or service may interest you. If you do not wish your contact information to be made available, please contact us via one of the following methods: Phone: 416-614-5831; Fax: 416-614-8861; E-mail: mary@newcom.ca; Mail to: Privacy Officer, 451 Attwell Drive, Etobicoke, ON M9W 5C4. Canada Post product agreement No. 40063170. Oral Hygiene is published quarterly by Newcom Business Media Inc., a leading Canadian magazine publishing company. ISSN 0827-1305 (PRINT) ISSN 1923-3450 (ONLINE)
September 2017 www.oralhealthgroup.com
ROUND FOR A REASON Unique round CrossAction brush head
Brush pressure monitoring system
Unlike a rectangular head, the round, prophy-inspired ORAL-B® brush head provides three-side cleaning to all tooth surfaces.
Only Oral-B® has a Triple-Pressure Control System to detect over-aggressive brushing and provide the patient with a visual 360° SmartRing alert.
Oral-B® GENIUSTM CrossAction Cleans Better than Sonicare DiamondClean*
Innovative Position Detection Smartphone app helps the patient improve their brushing technique by showing the areas they’re missing. Oral-B® Pro CrossAction Oscillating/Rotating Pulsating Action
Sonicare DiamondClean Side-to-side Action
Recommend Oral-B® GENIUSTM to your patients so they never miss a zone.
* Based on multi-week clinical studies Sonicare is a registered trademark of Koninklijke Philips N.V.
© P&G 2016
ORAL-20485
Our mission is to increase trust and loyalty of your patients by optimizing the predictable clinical outcomes of your dental hygiene department!
BOOK REVIEW
INNOVATIVE SOLUTIONS AGAINST XEROSTOMIA, ORAL LESIONS AND CARIES!
THE ELITE PRACTICE FORMULA Carlo Biasucci, DDS Dear Doctor,
W
Available at
Xerostomia X-PUR Gums and pastilles: Only ones indicated to stimulate saliva production Xylimelts: Only pastilles indicated to stimulate saliva during sleep
Oral Lesions Gengigel: Hyaluronic acid topical gel
Caries X-PUR Opti-Rinse: High strength fluoride rinses with 10% Xylitol X-PUR Remin: Fluoride free toothpaste indicated to reduce cavities
To order, register for a course or get your recommendation pads and samples: 1-888-442-7070 www.oralscience.com/en-pads
hen I wrote this book, “The Elite Practice F Formula”, it was not intended to be the bible of running an Elite Practice. My goal was not to tell you exactly what to do. My goal was to get you to think differently about your practice, and start to question some of the tightly held conve conventions of our profession. You will pick up some pearls and learn some things that you can immediately implement, but I will have succeeded if I have ignited in you at least a spark of dissatisfaction with the status quo, and the mindset to start questioning why you are accepting where you are, rather than aiming to realize your true potential. The best way to get serious value from this book is to read it with a notepad nearby, and for each chapter, write down at least one thing that you know must change in your practice. Then from that list, create action items, and delegate as much as you can of it to get that list done. If there’s one thing I have seen, it is this: The most successful business owners in any room are always the ones who buy the product that can help them first, and adopt practices before they are the norm. They are also the ones who are decisive and take action quickly. I promise that if you put these ideas and principles to use, you will reap the reward. P.S. We treat our clients the way we would like to be treated. If you are not completely satisfied with your order, please let us know so we can help you at (888) 561-4123 or email info@theelitepractice.com.
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ORAL CLINICAL HYGIENE
EMPOWERING PERIODONTAL THERAPY Sheri B. Doniger, DDS is a leading dental clinician, author, international educator, and consultant who currently practices dentistry in Lincolnwood, IL. Dr. Doniger is an avid researcher, frequently contributing to an array of dental publications on a variety of topics. She is a member of the IZUN Oral Healthcare Scientific Advisory Team. Please free to contact Dr. Doniger at www. donigerdental.com. Clinical photos courtesy of Dr. William Z. Levine
10
According to the CDC, “47.2% of adults aged 30 years and older have some form of periodontal disease. Periodontal disease increases with age, 70.1% of adults 65 years and older have periodontal disease.”1 The numbers of adults with untreated periodontal disease are high. The dental hygienist is front line defense in the office for periodontal disease. She or he is the first to see the patient, evaluate the periodontal status then be closely involved with treatment. Directly treating the patient, the dental hygienist is able to educate about the sequellae of periodontal disease, instruct in proper home care and actively have an important role in direct patient care. Periodontal disease is both an inflammatory and infectious disease. Bacteria inhabit the biofilm, and the resultant infection will cause an inflammatory reaction. The local inflammatory reaction is the primary driver of the disease, which will activate the innate immune system response. Failure to encapsulate or control the inflammation within the gingival tissues will result in the expansion of the response into the bone, causing the destruction of connective tissue and alveolar bone. In periodontal disease, the inflammatory response is not effective in resolving the lesion but actually perpetuating it. We need to control both the infection and the inflammation for periodontal health. 2,3,4 Traditional non-surgical treatments of scaling and root planning as well as mechanical removal of plaque are historically delegated to the hygienist. Antibacterials were added to treatment regimens during the mid-seventies, and have been added to the standard periodontal treatment arsenal. 5,6 In the nineties,
sustained release delivery of antimicrobials, such as PerioChip® and Arrestin®, were added to non-invasive periodontal treatment.7,8,9 We are now looking into host modulation10 used in conjunction with the other therapies available.11,12 The additional antimicrobial, anti-inflammatory and tissue rebuilding patches are easily incorporated into the traditional treatment.12,13 Focusing on the on the host aspect of periodontal disease, these modulation therapies work to decrease or inhibit the destructive effects of the host response and increase more protective, healing aspects, allowing the immune inflammatory reaction to bacterial plaque to be less damaging to the tissues.14 Please see Figure 1. Working with the model of host modulation and increasing the healing components of the inflammatory response is a proactive method
Bacterial Component + Host Response Component = Clinical Sequelae
FIGURE 1: Periodontal Disease Model (Kornman, K. J Periodontol • August 2008)14
September 2017 www.oralhealthgroup.com
CLINICAL
TABLE 1: PeriActive™ and PerioPatch™ uses
of treating periodontal disease. Dental hygienists are able to expand their functions to utilize a novel non-invasive treatment, along with their traditional scaling and root planning procedures, which provides anti-inflammatory, tissue rebuilding and antibacterial therapy. PerioPatch™ is a wound healing patch that contains high dose, focused delivery of bioactives derived from plants.15 The indication for these unique healing patches are for acute or highly inflamed sites, post scaling and root planing, recession and a myriad of other therapeutic needs. PerioPatch™ reduces inflammation and promotes healing. This patch uniquely absorbs exudate from the gingiva and crevicular fluid to aid in healing. Used with PeriActive™ rinse, there is an additive effect of anti-inflammatory, antibacterial and promoting tissue healing. Please see Table 1 and Figures 2 and 3. PerioPatch™ contains extracts of three optimized botanicals (Centella asiatica, Echinacea purpurea and Sambucus nigra), all found to be clinically effective in reducing inflammation and prohealing. Studies have shown Centella increases collagen production. Centella exhibits anti-bacterial activity in addition to reducing the glucoronidase, which has been associated with gingival inflammation. Both
FIGURE 2: Periodontal pocket with ulcerated epithelium and bacteria attacking the collagen
FIGURE 4: Adhering the PerioPatch™ to affected area
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PERIACTIVE AND PERIOPATCH MAY BE USED • Adjunctive to Scaling and Root Planing • Early stage recession • Adjunctive to surgical treatment and extractions • Treat and prevent peri-implantitis • Oral wounds • Intraoral chemical burns • Traumatic ulcers or abrasions • Cheek bites • Denture sores • Every day rinse for gingivitis and periodontal patients TABLE 2: Botanicals present in PerioPatch™ Centella asiatica
Irritation/gingivitis reducer
Sambucus nigra
Irritation/gingivitis reducer gum repair stimulator
Echinacea purpurea
Irritation/gingivitis reducer
Sambucus and Echinacea exhibit anti-inflammatory and anti-bacterial effects.16,17 After scaling and root planing an affected site, placement of this topical healing PerioPatch™ will draw out the inflammatory exudate and help tissue regeneration by facilitating the deposition of collagen in the wound area.18 The patch is a hydrogel, which has
FIGURE 3: Scaling and curettage cleaning the infected pocket
FIGURE 4: Inflammation is drawn to the patch while immune cells are brought into the infected area
September 2017
11
CLINICAL
FIGURE 5: Bacteria and inflammatory fluid are drawn to the PerioPatch™
FIGURE 6: Inflammation is reduced and healing fibroblast cells are depositing collagen
FIGURE 7: Healing cells close the ulceration and fibroblast cells deposit collagen
been utilized in wound healing in medicine. It is a novel approach in dentistry, applying bioactives directly to the tissue. Unlike locally applied antibiotics, this patch sits on the outer aspect of the gingival tissue and draws out inflammatory exudate while acting as a barrier.19 The dental hygienist or dentist will place the initial patch (Figure 4). The patch remains in place for approximately fifteen to sixty minutes, and then the outer cellulose backing will fall off. The hydrogel can remain on the tissue for up to five hours, but is usually no more than sixty minutes. Depending on the clinical extent of treatment, multiple patches may be placed. While placing the patch, it is helpful for the patient to observe. The patient will then apply one more patches on the first day and two patches for the next three days on the affected areas. It is important to instruct the patient they should not eat or drink during this time the patch is in place to maximize the effectiveness of the hydrogel. In conjunction with the PerioPatch™, the use of a botanical, non-alcohol rinse of PeriActive™ will further decrease inflammation, decrease plaque and improve healing to the area. The hydrogel serves several purposes: it will protect and cover the pocket to prevent any
FIGURE 8: Infected pocket vs. Healthy pocket post treatment
12
FIGURE 9: Mean PD Reduction and CAL Gains at 4-6 Weeks above SRP with PerioPatch™ versus Approved Adjunctive Antimicrobials 22
Continued on page 15
FIGURE 10: Combined effect of utilizing both PerioPatch™ hydrogel and PeriActive rinse on reducing pocket depths 22
September 2017 www.oralhealthgroup.com
WHERE ACID MEETS ITS MATCH. Crest® Pro-Health Advanced Contains Stannous Fluoride For Healthier, Stronger Teeth. TM
1. Stannous fluoride remineralizes weakened enamel.
2. Stannous fluoride creates a micro thin shield to prevent acid erosion and treat sensitivity.
3. Stannous fluoride significantly inhibits plaque bacteria acid production.
with SHMP
Stannous fluoride Untreated
POLYETHYLENE BEAD-FREE STAIN-FREE
© P&G 2016
ORAL-20443
continuing the care that starts in your chair
Four generations of dependability. Earned one day at a time.
For over 100 years, dentists and hygienists have turned to us to improve their daily procedures and practices. Whether restorative, preventive, endodontic, prosthetic or ďŹ nishing, we’ve been doing exactly that – creating materials, devices and products that take dentistry to new heights of dependability, ease-of-use and patient satisfaction – each and every time.
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CLINICAL
Continued from page 12
FIGURE 12: Pretreatment
FIGURE 13: Patch in place
FIGURE 14: One day post op
FIGURE 15: One year post op
FIGURE 16: Pretreatment
FIGURE 17: Pretreatment
FIGURE 18: Patch in place
further irritation, while absorbing the excess inflammatory fluid. This will result in a decrease in clinical inflammation 20 and an increase in collagen and fibroblast deposition, allowing for better healing of the area. Focusing on delivering direct bioactives that will assist in healing and reducing inflammation, along with a diligent effort by the patient with oral home care, the reduction in pocket depths are apparent. PerioPatch™ not only helps draw out exudate and reduce inflammation but will en-
hance the gingiva to repair (Figures 5, 6, 7 & 8). The average volume of gingival crevicular fluid in a healthy individual is 3μL. For a patient with moderate periodontal disease, the fluid volume is 20 μL. Patients with advanced periodontal disease have fluid levels of 44μL PerioPatch™ can absorb up to 140μL within an hour. The patch gives the patient immediate relief while accelerating healing and protecting the site. This reparative function is key in helping our patients with their periodontal issues. Drawing out the pro-inflammatory flu-
(Photos Courtesy of Dr. William Z. Levine)
FIGURE 11: Pretreatment
September 2017 www.oralhealthgroup.com
15
CLINICAL
FIGURE 19: Post treatment one month
id from the gingival and sulcus will rebalance the tissues by assisting the natural healing and tissue repair. 20 The favorable reduction in pocket depths, improvement in bleeding upon probing, along with the increase in clinical attachment gains have been demonstrated (Figures 9 & 10). 21,22
References:
16
1. https://www.cdc.gov/oralhealth/periodontal_ disease/ Accessed March 2, 2017 2. Teles, R., Teles, F., Frias-Lopez, J., Paster, B., Haffajee, A. Lessons learned and unlearned in periodontal microbiology. Periodontol 2000. 2013 Jun; 62(1): 95–162. 3. Cochran, DL. Inflammation and Bone Loss in Periodontal Disease. Journal of Periodontology August 2008, Vol. 79, No. 8s, Pages 1569-1576, 4. Brasswell, Laura D. Targeting the host Dentistry Today http://www.dentistryiq.com/articles/wdj/print/volume-2/issue-2/focus-onperio/targeting-the-host.html 5. Slots J, Ting M. Systemic antibiotics in the treatment of periodontal disease. Periodontology 2000. 2002;28:106–176. 6. Beliveau, D, et al. Benefits of Early Systemic Antibiotics in Localized Aggressive Periodontitis. A Retrospective Study J Clin Periodontol. 2012 Nov; 39(11): 1075–1081. 7. Friedman M, Steinberg D. Sustained-release delivery systems for treatment of dental diseases. Pharm Res. 1990 Apr;7(4):313-7 8. Williams RC, Paquette DW, Offenbacher S, et al. Treatment of periodontitis by local administration of minocycline microspheres: a controlled trial. J Periodontol 2001;72:1535-1544. 9. Jeffcoat MK, Palcanis KG, Weatherford TW, Reese M, Geurs NC, Flashner M. Use of a biodegradable chlorhexidine chip in the treatment of adult periodontitis: clinical and radiographic findings. J Periodontol 2000;71:256-62. 10. Golub LM, et al. Modulation of the host response in the treatment of periodontitis. Dentistry Today 1998; 17(10):102-109.
FIGURE 20: Post treatment three months
11. Paquette DW, Levine WZ. Adjunctive Treatment of Periodontal Disease with Self-Adhesive Hydrogel Wound Dressing: Case Series. Compend Contin Educ Dent. 2015 Jun;36(6): e12-4. 12. Levine WZ, Samuels N, Eliya- Barsheshet MM, Grbic JT. A Novel Treatment of Gingival Recession using a Botanical Topical Gingival Patch and Mouthrinse. J Contemp Dent Pract 2013;14(5):948-953. 13. Samuels N, Saffer A, Wexler ID, Oberbaum M. Localized Reduction of Gingival Inflammation Using Site-specific Therapy with a Topical Gingival Patch. J Clin Dent 2012;23:64–67 14. Korman, K. Mapping the Pathogenesis of Periodontitis: A New Look Journal of Periodontology August 2008, Vol. 79, No. 8s, Pages 15601568 15. Paquette, ibid 16. Punturee K, Wild CP, Kasinrerk W, Vinitketkumnuen U. Immunomodulatory activities of Centella asiatica and Rhinacanthus nasutus extracts. Asian Pac J Cancer Prev. 2005;6(3):396400. 17. Mishima S, Saito K, Maruyama H, et al. Antioxidant and immunoenhancing effects of Echinacea purpurea. Biol Pharm Bull. 2004;27(7):10041009. 18. Nemcovsky, Carlos E. A novel device to enhance soft tissue healing: Clinical applications of PeriZone PerioPatchTM in a variety of cases. Dental Products Report September 2012 19. Saffer, A., Samuels, N. A Novel Adjuvant Treatment to Scaling and Root Planing With a Topical Gingival Patch: A Case Series. Clinical Advances in Periodontics. August 2012, Vol. 2, No. 3, Pages 123-127 20. Smiley CJ, Tracy SL, Abt E, et al. Evidencebased clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc 2015;146:525-35. 21. Saffer, ibid 22. Paquette, ibid 23. Levine, ibid
September 2017 www.oralhealthgroup.com
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HEALTH Gordon Levin DMD, RYT is a dentist in general private practice and a certified yoga teacher.
18
STRAIN AND PAIN IN THE DENTAL PROFESSION Like many other professions and occupations, that of our profession of dentistry is filled with stresses, strains and long held static postures. The long term results can be sometimes quite debilitating for dentists, assistants, hygienists and receptionists. There are multiple factors involved in the development of favorable or unfavorable outcomes from our repetitive routines. Anyone involved in dentistry is aware of the potential for stress to become a negative factor. There is a growing body of scientific evidence that directly links long term stress to physical problems often with a strong inflammatory component. Quite apart from stress itself, long held static postures can lead to pain, tightness and myofascial related trouble. In order to try and get a glimpse of what our fellow dental workers are experiencing, a survey entitled “Pain and Strain in the Dental Profession� was distributed to many dental offices in Vancouver, Victoria, Duncan, Kelowna, Nanaimo and a few other locations within British Columbia. A cover letter was attached to the survey explaining the purpose of the survey to get a better understanding of our common problems and solutions. A total of 160 completed surveys were returned to the author by prepaid envelopes. Of the respondents, 61 were dental assistants, 30 hygienists,
34 dentists and 35 receptionists. The survey asked the following questions; what is your role; dentist, dental assistant, hygienist, or receptionist? What is your gender? What is your age? How many years of experience? Is there work related pain or limitation of movement? Location of the pain, or weakness with key locations offered; e.g. neck, back, shoulder, wrist, fingers, etc. Underlying preexisting conditions, e.g. arthritis, fibromyalgia, diabetes, auto or sports injuries, or other? What is the degree of seriousness of the condition, not serious, somewhat or very serious? What has been the source of help sought? Example; doctors, chiropractor, physiotherapy, and massage. What is the effectiveness of treatments: not at all, a little bit, somewhat or very helpful? Respondents were also asked if they felt that they received adequate training regarding posture and body positioning during their education. Does the stress at work affect your mental and/or emotional well-being mildly, moderate, extremely? Are your remedies for stress adequate? What are your remedies? Athletics, TV, alcohol, prescription drugs, nonprescription drugs, massage, yoga? The final question of the survey asked whether any of the conditions described, physical or other, were perceived as leading to a possible disability.
September 2017 www.oralhealthgroup.com
HEALTH The following are the results of the survey. Age of respondents ranged from 20-60 years. Experience ranged from less than 5 years to over 25 years. Work related pain or limitation of movement: All respondents: 114 of 160 yes ................. 71% Assistants (greatest) 45 of 61 yes .............. 74% Dentists (least) 21 of 34 yes .......................62% Weakness of grip: Assistants..................................................... 41% Assistants with 15 years’ experience .......56% Hygienists ....................................................40% Location of body problems: All responders: Back..............................................................59% neck ..............................................................58% wrist ..............................................................32% fingers ...........................................................24% hips ...............................................................18% Neck problems: Receptionists...............................................77% Assistants.....................................................57% Dentists ........................................................50% Hygienists ....................................................47% Assistants with 15 years’ experience .......78% Hygienists with 15 years’ experience .......62% So it seems that with more time, our chosen career in dental practice, comes also a greater likelihood of musculoskeletal trouble, especially in vulnerable locations such as the neck.
In fact of all respondents in various roles for 15 years or more those reporting pain or limitation of movement were: Receptionists..............................94% (16 of 17) hygienists ..................................... 90% (9 of 10) assistants .................................... 85% (23 of 27) dentists ........................................67% (14 of 21) The perception of the seriousness of our problems is also very interesting: Problems not too serious: Dentists ........................................................68% assistants ......................................................62% hygienists .....................................................53% receptionists ................................................ 41% Conversely problems somewhat to very serious: Dentists ........................................................32% assistants ......................................................38% hygienists .....................................................47% receptionists ................................................49% As for perception of efficacy of treatment sought to combat these musculoskeletal problems: Very effective: Dentists ........................................................50% receptionists ................................................33% hygienists .....................................................27% assistants ......................................................23% Most popular professional help; massage therapy..........................................49%
September 2017 www.oralhealthgroup.com
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HEALTH
chiropractic..................................................40% yoga ..............................................................30% physiotherapy .............................................. 16% medical doctor ............................................12% In addition 31% of respondents take antiinflammatory drugs for their conditions. Future disability anticipated (work related): hygienists .....................................................30% assistants ......................................................27% dentists ......................................................... 16% receptionists ................................................ 14% said yes (entire study group 24%) Does stress affect you are work? Dentists ........................................................85% receptionists ................................................66% assistants ......................................................59% hygienists .....................................................57% said yes (66% of all respondents). Do your stress remedies work for you? Dentists ........................................................85% receptionists ................................................ 74% assistants ......................................................72% hygienists .....................................................67% said yes (74% of all respondents). Popular remedies for stress were: athletics/exercise .........................................68% television ...................................................... 61% massage ........................................................46% yoga ..............................................................32% alcohol ..........................................................25% Of the 108(of 160) who use athletics/exercise 72 or 67% are stressed by work, and of these, 27 or 25% have ineffective stress remedies. Furthermore, in this exercise group, 38% have somewhat or very serious pain/range of motion problems with 23% ineffective remedies and 24% headed towards disability (in their opinion).
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Among the yoga practicing 65% (36 of 55) are stressed at work, 29% with ineffective pain/ range of motion remedies. 14 or 25% headed for perceived disability. When we looked at the people (38) using both yoga and exercise the results are almost identical to the above 2 groups (that are themselves virtually identical). Furthermore, stress incidence is the same as the overall group, and so is the effectiveness of stress remedies. (70 to 75%) What is also identical is the proportion of those who fear impending disability, about 25% for everyone. That is, the total of all respondents, the yoga people , the yoga/ exercise people all have the same sense of impending disability. Although the sample size is relatively small at 160 respondents spread among dentists, hygienists, assistants and receptionists, the results may be pointing to some significant problems that stem from our work. Further study conducted on a larger scale is called for here. My own personal history, dentist for over 25 years, long term exercise and athletics devotee, yoga student for 10 years and yoga teacher for 3 years gives me a special interest in the problems of work related somatic and stress nature. I confess to having been a little surprised at the seeming lack of advantage from exercise, athletics, or yoga to help out, until I thought about it. In my personal experience, until I found yoga, I suffered from ongoing musculoskeletal trouble in my shoulder and neck with a lot of myofascial discomfort. In retrospect, until I found some particularly gifted therapeutic yoga teachers, I did not develop a daily routine that really worked well for me. Having attended some dental conference lectures given by certain physiotherapy experts and also looking at therapeutic/ preventive exercises recommended by some chiropractors, I be-
September 2017 www.oralhealthgroup.com
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HEALTH
lieve that there are many well designed and intelligent series of remedial stretches and poses (involving the use of controlled breathing) from many sources (physios, chiropractors, therapeutic yoga teachers, etc. ). As for relieving stress; there are also a great many sources available, and we can look at that in greater detail in a further study as well. From my own personal experience in successfully combating somatic (body) and psychological stresses and strains from work as a dentist I have found this: find things that you can do on a consistent (near daily) basis that seem to work for you and stick to them! They must, however, be designed to deal specifically for you and your particular problems. If your hot yoga class or other work out rou-
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tine you may do is not helping to relieve your stress and strain you may very well find what you need elsewhere. Practitioners of somatics, physiotherapy, therapeutic yoga, etc. can be found and are of enormous help. Having found for myself a daily routine of therapeutic yoga techniques that have solved and continue to solve my own neck and shoulder strains, I know similar solutions await you. As for stress relief there are so many excellent choices, for example community involvement and volunteerism, are proven to relieve stress. If you find sitting and meditating is not for you, try walking calmly in a place and setting you enjoy while breathing slowly, fully, and calmly. You may be surprised at how well this “walking meditation� will work for you.
September 2017 www.oralhealthgroup.com
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A NEW GENERATION OF FLUORIDE VARNISH IS COMING TO YOU! Sylvie Martel, RDH, DipDH, Teaching Certificate NDHCB Sylvie is a seasoned international speaker, entrepreneur and educator. She works in close collaboration with the corporate sector as a lecturer, key opinion leader, trainer, writer and education specialist. She is the dental hygiene advisor for the National Dental Hygiene Certification Board of Canada, she sits on the board of the Commission on Dental Accreditation of Canada, and works as a consultant for certain dental hygiene regulatory bodies in Canada.
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The efficacy of fluoride varnish in the prevention of dental caries, remineralization of tooth surfaces and treatment of dentin hypersensitivity is well supported by literature. Varnishes allow for the delivery of high concentrations of fluoride in small amounts. Furthermore, the effectiveness, the relative safety, the uptake of this form of delivery combined with its ease of application offer significant advantages over other professionally-applied topical fluoride treatments like fluoride gels, foams, and mouthrinses. The first fluoride varnish was marketed in 1964 under the trade name Duraphat. This new form of delivery for topical fluoride was created in order to have a fluoride vehicle that would ensure a longer contact time between the fluoride itself and the tooth surface in order for the treated areas to become more resistant. Fluoride varnish is composed of a high concentration of sodium fluoride in a fast-drying alcohol and resin-based solution. Currently most varnishes on the market include 5% sodium fluoride (NaF) which equals to 2.26% fluoride by weight (or 22.6 mg fluoride/ml or 22,600 ppm fluoride). To ensure the varnish is sticky and adheres to the tooth surface, most products use a resin-based additive such as colophony (rosin derived from pine tree sap). The Contact Allergen Database defines colophony as a sticky, amber material distilled from the sap of pine trees that can be found in a wide variety of products including but not limited to, cosmetics, adhesives, cements, waxes, and fluoride varnishes. An hypersensitivity to rosin would appear as a localized contact dermatitis that would tend to occur at
contact or 1 to 3 days later. Some clients treated with a colophony-based fluoride varnish could potentially develop an allergic response to pine. Acting as a vehicle for the fluoride agent, the resin also delays the bioavailability of the fluoride and does not allow the application of a truly fine coat of varnish on the client's teeth. A major complaint from clients is that the film thickness is detectable, unpleasant and with pedo clients especially, it may be uncomfortable or an unwanted treatment option. Furthermore, the film could also be removed prematurely either voluntarily or involuntarily because of increased friction. It is also important to note that fluoride varnishes need the presence of saliva to either help with the precipitation of the fluoride, the dispersion of the fluoride and/or the crystallization process of the varnish on the teeth. When looking at the efficacy of fluoride varnishes, Petersson, in 1997, demonstrated the significant caries reducing potential of fluoride varnishes which was also reiterated by many other researchers since then. Also, numerous in vivo and in vitro studies have shown that fluoride varnish is able to supply fluoride more efficiently to the enamel when compared to other topical fluoride agents, and is able to reduce considerably the incidence of dental caries. The Cochrane Review on the efficacy of fluoride varnishes published in 2013 concluded that young people treated with fluoride varnish experienced on average a 43% reduction in DMFT (decayed, missed, filled tooth surfaces), and in 10 trials looking at the effect of fluoride varnish on baby teeth, the evidence suggested a reduction on average of 37% in DMFT. Even if the level of evi-
September 2017 www.oralhealthgroup.com
PRODUCT PROFILE dence was rated as moderate because of the bias and the heterogeneity of the studies retained, the Cochrane review is the highest level of evidence we have on the efficacy of fluoride varnishes. Guidelines published by the American Dental Association recommends in-office application of fluoride varnish every three to six months for clients at moderate and high risk for dental caries. As stated previously, most fluoride varnishes on the market have a concentration of 5% NaF. In 1988, Seppä investigated the effects of one sodium fluoride solution and a varnish with two different fluoride concentrations on enamel remineralization in vitro. It is important to understand that the effectiveness of a topical fluoride is primarily a function of the amount of fluoride uptake that can be achieved in demineralized areas. Fluoride uptake is affected by the concentration of fluoride in the agent, the contact time, and the ability of the product to induce the migra-
tion of the fluoride into the tooth structure. The results of this study suggested that the efficacy of the fluoride varnish was not proportional to the fluoride concentration (2.26% F varnish versus 1.13% F varnish, fluoride by weight which equates to 5% NaF and 2.5% NaF, respectively), but rather the number of
September 2017 www.oralhealthgroup.com
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PRODUCT PROFILE
applications. In this study, a 5% NaF varnish applied three times within a week was slightly more effective in enamel remineralization than a 2.5% NaF varnish, but no significant difference was found between one application of 5% NaF or one or three applications of 2.5% NaF varnish. The 0.1% NaF solution FIGURE 1: Better Fluoride Release (Availability) (EFU as % of total theoretical fluoride release in formula)
With FluoriMax™, approximately 40% of the fluoride goes to the teeth. Source: Final Report: Enamel Fluoride Uptake Study Number 28 FDA, Method #40, Therametric Technologies, Inc., 2015.
FIGURE 2: Better Fluoride Uptake (Absorption) (PPM, μg de F /g varnish)
FluoriMax delivers 58% more fluoride uptake than 3M Vanish. Source: Final Report: Enamel Fluoride Uptake Study Number 28 FDA, Method #40, Therametric Technologies, Inc., 2015.
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was the least effective when compared to the two different fluoride concentrations in the varnish form. Furthermore, enamel treated three times within a week with a 2.5% NaF varnish showed the greatest acid resistance when subjected to a 1-hour demineralization treatment. This study suggests that not fluoride concentration but number of applications may yield better enamel remineralization and protection, and that initial enamel fluoride saturation was fairly equivalent at both concentrations. Seppä et al, in 1994, did a similar trial using different concentrations of sodium fluoride in varnishes and assessed the caries preventive effect and found similar conclusions to the 1988 study; whereas the difference between a 1.1% F or a 2.3% F varnish was minimal on 274 children aged 12 to 14 years old who received 3 annual applications of either one concentration or the other, over a period of 3 years. Ahmed et al, in 2013, also concluded in an in vitro study that a concentration of 2.5% NaF is an optimal concentration of fluoride to obtain the saturation of tight and loose binding sites on hydroxyapatite discs. These studies suggest that a varnish with a concentration of 2.5% NaF is sufficient to achieve anti-caries protection without any risk for dental fluorosis, if this is a concern of the clinician, especially in young children. With that information in hand, why not rethink your product selection to include a fluoride varnish that offers great benefits for the clinician and the client at-risk for dental caries or erosion? The unique formulation of Fluorimax™ includes a 2.5% NaF (11,300 ppm F) concentration that has been proven to be effective in enamel remineralization and protection of the dentition against acid erosion, and have shown to provide superior fluoride uptake when compared to traditional colophony-based varnishes (Figure 1). Furthermore, Fluorimax™ is a hypoallergenic solution that does not use colophony but a colorless dewaxed food-grade shellac to which they added hydroxyapatite, that will act as the driver of the fluoride. It provides the clinician assurance of no potential allergic reaction, and the ease of use, because of its liquid form, allows for an increased bioavailability of the fluoride and a low film thickness. With this fluoride varnish, the clinician can apply a very thin coat that flows easily into the interproximal areas, dries
September 2017 www.oralhealthgroup.com
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quickly and leaves a smooth clear coat on the client's teeth. With its superior fluoride release and fluoride intake (Figure 2), this new varnish may revolutionize the way we choose our professionally-applied topical anticariogenic agents. Fluorimax™ is a new option - an easy to use fluoride varnish without colophony, that flows well, adheres firmly to tooth surfaces, dries quickly, requires only a small amount of product to cover the entire dentition thus reducing the risk of ingestion of too much fluoride and any side effects associated with this behaviour, and is effective and safe to use with clients of all age groups. In conclusion, dental professionals are responsible to keep abreast of the latest evidence that will guide how they customize their clients' treatment plan. Fluoride varnish is a very important option to recommend for caries and sensitivity management in your practice. It has a proven record! Are you using it to its full potential? DISCLOSURE: Sylvie Martel is an independent dental hygienist consultant and key opinion leader for a number of leading dental corporations and has received financial compensation from Oral Science for writing this article.
References: •
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ADA Council on Scientific Affairs, Topical fluoride for caries prevention: A systematic review and evidence-based recommendations, 2013, ADA Center for Evidence-based dentistry. https://ebd.ada.org/~/media/EBD/Files/Topical_fluoride_for_caries_prevention_2013_update.ashx Ahmed I, Coleman SS, Carey CM, Fluoride release and uptake into hydroxyapatite from experimental dental varnish, March 2013. Paper presented at IADR 2014. Azarpazooh A, Main PA, Fluoride Varnish in the
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Prevention of Dental Caries in Children and Adolescents: A Systematic Review, J Can Dent Assoc 2008;74 (1), 73-79. https://www.cda-adc.ca/jcda/vol-74/issue-1/73. pdf Chu CH, Lo E, Uses of sodium fluoride varnish in dental practice. Ann R Australas Coll Dent Surg., 2008 Jun; 19:58-61. Contact Allergen Database on Colophony: www.contactallergy.com accessed on February 06, 2017. Final report: Enamel fluoride uptake study number 28 FDA, Method #40, Therametric Technologies Inc., 2015. Hoang-Dao BT, Hoang-Tu H, Tran-Thi NH, Koubi G, Camps J, About I, Clinical efficacy of a natural resin fluoride varnish (Shellac F) in reducing dentin hypersensitivity, J Oral Rehabil 2009 Feb;36(2):124-131. Marinho VCC, Worthington HV, Walsh T, Clarkson JE, Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD002279. http://onlinelibrary.wiley.com/ doi/10.1002/14651858.CD002279.pub2/pdf/ standard Petersson LG, On topical application of fluorides and its inhibiting effect on caries, Odontol Revy Suppl. 1975;34:1-36. Seppä L, Effects of sodium fluoride concentrations on enamel remineralization in vitro. Scand J Dent Res 1988;96:304-309. Seppä L, Pöllänen L, Hausen H, Caries preventive effect of fluoride varnish applications with different fluoride concentrations. Caries Research 1994;28:64-67. Stookey GK, Caries prevention, J Dent Educ., 1998 oct;62(10):803-811. Weyant RJ, Tracy SL, Anselmo T, et al. Topical fluoride for caries prevention. Executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc. 2013; 144: 1279-1291.
September 2017 www.oralhealthgroup.com
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ORAL HYGIENE
HOW TO BE HAPPIER NOW! Mindfulness and the Dental Professional
Dr Gloria Alban, DDS, RHN With over 23 years of dental practice and more than 40 years of mindfulness training, Gloria has the ability to connect with her students and teach them to overcome stress and to be happier.
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The dental office is a great place to work. It is 5. Confidence increases through self-awarevery satisfying to be able to help patients imness and also by the ability to calm your prove their health while creating long term mind and recover when you lose your relationships and earning a good living. Uncool. fortunately, 83% of dentists and their staff Emotional intelligence includes self awareperceive their profession as very stressful. ness, self regulation, motivation, empathy and Coping with difficult, anxious patients, sched- social skills. These skills create the conditions uling stresses, causing pain and trying to pro- for our own long term happiness. A strong, duce perfect work in spite of having little con- stable and perceptive attention that creates trol over long term outcomes; these factors, calmness and clarity is the foundation upon and many more, cause more than half of den- which emotional intelligence is built. We need tists to report feeling tense, anxious or fre- to develop response flexibility; the ability to quently depressed. pause before we act. The pause gives us the Mindfulness is a simple concept that can be learned easily. Thou“I’ve got 99 problems and 89 of them are sands of well documented studies completely made up scenarios in my head have shown that the benefits of mindfulness practice include that I’m stressing about for no logical reason” stress reduction, decrease in anxiety and depression, reduced worUnknown author ry, less emotional reactivity, improved well being and even a strengthened choice as to how we want to act in that emotional situation. Mindfulness is very imporimmune system. Regular mindfulness practice has the poten- tant in the development of these skills. tial to prevent burnout and stress. The dental professional who is self-aware, HOW DOES MINDFULNESS WORK? increased through mindfulness, is more likely Mindfulness involves learning to pay attento engage in activities to better manage stress. tion in the present moment, non-judgementalThis self-awareness also increases self- com- ly. Even one mindful breath can enhance passion, reduces stress and leads to less chance calmness and relaxation. Physiologically, the slow and deep breath stimulates the vagus of emotional burnout. nerve which activates the parasympathetic SOME BENEFITS OF system resulting in reduced stress, lower heart MINDFULNESS TRAINING rate and blood pressure and general calming. 1. Improves the ability to calm your mind on Psychologically, when we put our attention on demand. the breath, we are fully in the present mo2. Helps to develop clarity of the mind lead- ment. This is an important skill to develop. ing to increased self-awareness. To feel regretful, we need to be “in the past” 3. Increases emotional intelligence and and to worry we need to be “in the future”. emotional resilience, especially in re- When we are in the present moment, we are sponse to emotional pain. free of regret and worry so our body enjoys a 4. Creativity grows as a result of a peaceful precious moment of rest and recovery. mind. Mindfulness helps to alter one’s perception
September 2017 www.oralhealthgroup.com
ORAL HYGIENE
“Between stimulus and response there is a space. In that space lies our freedom and our power to choose our response. In our response lies our growth and our happiness” Victor Frankel, Man’s Search for Meaning of stress and to improve coping skills. Mindfulness practice can improve attentiveness, active listening, empathy, patience, presence, equanimity and acceptance- all of these qualities are very important for a good dentist-patient relationship. Enhancing these skills can help to improve the quality of life for both the dentist and the patient.
WHY WE FEEL ANXIOUS, UNEASY AND WORRIED Our amygdala is the part of our brain that reacts immediately to threats and stress. Our ancestors survived by being able to quickly act on physical threats and so our brains developed with a negativity bias; it looks for bad news, reacts intensely to it and remembers every dangerous thing we have experienced so we are ready for it the next time. Our brains and nervous systems have been evolving for over 600 million years and still, the solutions to survival problems faced by ancient reptiles and cavemen are active in our brains today. In our modern world, most of our daily threats are not physical. Regardless, our amygdala reacts to present day fears and worries in the same way as it reacted to the cavemans’ problems. It floods our body with adrenaline and other hormones and these lead us to feel stress, have high blood pressure, develop medi-
“Happiness depends on ourselves.” Aristotle cal problems and to generally feel bad. We live in a modern high tech, fast paced world but our brain reactions are stuck in the ancient past. It’s not our fault that we worry; Our brains are programmed for survival to do this. The good news is that our neocortex has the ability to overrule the amygdala. The neocortex can reason and evaluate the messages from the amygdala and other parts of our brain and tell us that nothing is wrong.. we are not under attack...we can calm down. It sends us messages of comfort and confidence. There is a moment, about a quarter of a second, where the immediate reaction of the amygdala can
be prevented by the neocortex. A quarter second is not much time but we can learn to control our amygdala’s immediate reaction to stress. The key to feeling happier is to develop a better balance between the power of the amygdala and the power of the neocortex. A balance between the instant reaction of amygdala....REACT.... with the power of the neocortex....DO NOT REACT.. let’s look at this threat clearly and evaluate and then we can.... RESPOND.... appropriately. Mindfulness practice calms the vagus nerve which activates our parasympathetic system. We can learn to take power away from our amygdala and give more to our neocortex. We learn to respond instead of react!
TRY THIS SIMPLE EXERCISE There are many different types of mindfulness exercises that help to develop the ability to reduce anxiety, improve relaxation and to feel better. Following is a simple example to try that can give you some experience with the feeling of paying mindful attention. Start by sitting upright with your feet on the ground. Sit away from the back of the chair so your spine can be self-supporting with a sense of presence, here and now. Letting your eyes close or lowering your gaze. Focus on the breath moving into the abdomen; the sensations of each in breath and each out breath. There is no right way to feel. From time to time, you may notice that your mind wanders. This is what minds do. You have woken up and noticed.. this is awareness. Move your attention back to the breath. Each in breath a new beginning; each out breath, a letting go. Each time you mind wanders, notice what is happening and move the mind back to focusing on the breath, in and out. Continue this exercise for 3-5 minutes and congratulations, you have performed a mindfulness exercise.
HAPPINESS The great news about happiness is that it is highly trainable. Research suggests that we have a remarkable ability to adapt to both
September 2017 www.oralhealthgroup.com
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ORAL HYGIENE
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good and bad fortune and that we have a relatively stable level of happiness that we eventually return to even after major positive or negative life events. Approximately 50% of our happiness is associated with genetics and upbringing. The other half can be improved through mindfulness training. We can learn to incline our minds to become more joyful and feel happier.
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Mindfulness is about non-striving, contrary to our North American desire for always needing to have and do more. It is about becoming aware and accepting things as they are right now. This leads us to the ability to decide how much we want to do and how much is detrimental to our health and happiness. Ninety percent of our communication is non-verbal. Through body language, tone, response and eye contact we show our discomfort and disconnection when with our patients. Mindfulness gives us the space to become aware of our own processes and the clarity to respond effectively instead of simply reacting to a situation. As dental professionals, we need to take care of our own stress and anxiety in order to help ourselves and our patients. Mindfulness offers a respite from stress, moment by moment. Enrolling in a mindfulness course is a simple way to learn techniques that can improve your life!
References 1) Mindfulness-Based Cognitive Therapy for Depression; Segal, Willams, Teasdale, The Guildford Press, New York, 2013 2) Joy on Demand; Chade-Meng Tan, Harper Collins, 2016 3) Search Within Yourself, Chade-Meng Tan, HarperCollins , 2012 4) 10% Happier........ 5) The Myths of Happiness; Sonja Lyubomirsky , Penguin Press, USA, 2013 6) What Happy People Know; Dan Baker and Cameron Stauth, 2003 7) Hardwiring Happiness; Rick Hanson, Harmony Books, 2013 8) http://onlinelibrary.wiley.com/doi/10.1111/ medu.12200/full 9) https://www.omicsonline.org/management-andprevention-of-burnout-in-the-dental-practitioner-2161-1122.1000168.pdf
September 2017 www.oralhealthgroup.com
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PRODUCT PROFILE
An Alternative Practice setting for one Canadian Dental Hygienist started with a simple idea.
“Clip Mirror improves dental hygiene treatment” Patricia Blundon
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Canadian Dental Hygienist, Patricia Blundon, is the developer of a dental mirror that clips on to a saliva ejector to aid dental hygienists, assistants, and clinicians in treating patients. In response to growing demand for the Dental Hygiene Clip Mirror, she has introduced the device to the U.S. market and plans to expand her business globally. Ms. Blundon states that she decided to introduce the Clip Mirror™ in the U.S. after years of market research and positive feedback from Canadian customers. Dentistry is world-wide so the sky is the limit” Ms. Blundon, who has been a Dental Hygienist for over 25 years, says she came up with the idea for the mirror about 10 years in to her career. “With an electric scaler spraying water in one hand and a mirror in the other and the patient’s tongue pushing out the saliva ejector, I thought about having a mirror clip directly on to the saliva ejector to free up a hand and wondered why no one had invented this. I thought who better than a dental hygienist to design something that a dental hygienist uses so I put the gears in motion to learn everything I could about inventing.” The Clip Mirror™ was designed to make the job of dental hygienists and clinicians easier on their body and more efficient. As the population ages, dental clinicians may find themselves using a less than ideal posture while craning their necks and contorting their bodies to complete the necessary treatment. Ms. Blundon encourages all dental hygienists to explore and use products and techniques to help maintain proper posture. “You may not feel it right now but the damage is happening every day with every patient and eventually those minutes of compromised posture start to take their toll on your body and start speaking to you… sometimes it is a whisper and sometimes it is a loud sharp pain.” Production of the Clip Mirror™ began with medical grade 400 series stainless steel, so
that it would not rust or corrode and a precisely designed clip to snap securely to the saliva ejector while still allowing rotation if needed. The rolled clip ends allow one to feed a line of floss through and attach the Clip Mirror™ to the saliva ejector using sterile tape as an added precaution. The clip is then hand welded to a titanium mirror as the standard rhodium fails in comparison to brightness and transillumination. The Clip Mirror™ is available with a size 5 mirror and will be introducing size 4 and size 3 (Clip Mirror Mini™) in the near future. Throughout the process of patent applications to production, Ms. Blundon says she has learned a lot and encourages other with great ideas to follow her lead and just start by writing down their idea, and searching the internet for similar products or ideas. Ms. Blundon offers her Mentor Inventor tips on her Facebook page, The Clip Mirror by DH Essentials, and invites anyone with an idea to contact her directly for free mentoring advice. She says she received a lot of great help from others along the way and would like to pay it back by helping others achieve their own dreams. To learn more about DH Essentials and the Clip Mirror™ or to contact Patricia Blundon, email patricia@blundon.ca or visit the website at www.dhessentials.ca.
September 2017 www.oralhealthgroup.com
You’re ready for your practice to succeed. So are we. The Official Partner of Big Dreams. A dental practice is a business like no other. While you’re relentlessly focused on caring for your patients, you also have to plan around a wide range of financial realities. Let TD help. Our experienced business banking specialists have advice and financial solutions that are specific to the needs of a dental practice.
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DENTAL MARKETPLACE
Contact: Karen Shaw • tel: 416-510-6770 • fax: 416-510-5140 • e-mail: karen@newcom.ca Toll free: CDA 1-800-268-7742, ext 6770 • Toll free: USA 1-800-387-0273, ext. 6770
HYGIENISTS
NORTH MANITOBA HYGIENISTS NEEDED Dental office in north Manitoba is looking for two full time dental hygienists. Accommodation is available. Come and join our friendly team you can make 75k to 100k guaranteed per year. To apply email to 150 Chris.p1933@ yahoo.com
SAULT STE. MARIE, ON HYGIENIST WANTED Love your career at Northern Dental Care! Full time position available. Send CV to ashlee@ 150 northerndentalcare.com
CAREERS
NORTHERN ONTARIO Dental Technician Supervisor needed for full time position. Must be willing to relocate to Northern Ontario. The right candidate will be able to work under pressure, meet tight deadlines, have excellent manual dexterity and attention to detail. Must have 5 or more years of experience. English, Serbian and Ukrainian speaking an asset. Please e-mail resume to: dhc1091@eastlink.ca
SOUTHWESTERN ONTARIO Endodontist available. Alexandersevo@gmail.com 150 519.990.7386 EQUIPMENT
PORT ELGIN, ON Itero scanner 4 years old in excellent working condition for $15,000 Canadian. It comes with training in our office by staff who placed second in the scanning competition at the Invisalign summitt in Vegas. Please call Sarah at Port Elgin Orthodontics Ontario 519-832-2121 or e-mail: 150 flyngdoc@gmail.com
ASSOCIATESHIPS LABRADOR CITY, NL Enthusiastic dentist required for a family dental practice, in Labrador City, Newfoundland,friendly staff to assist you. For further information, please contact Rehan at 709 944 4294 150 or e-mail rmalik@crrstv.net
36
September 2017
ASSOCIATESHIPS
DAWSON CREEK, BC Looking for FT associate skilled in all aspects of general dentistry in an established practice in Dawson Creek, BC. Associateship could lead into buy-in or purchase. Knowledge of German and/or Russian could be a plus. Dentist/owner could provide rental home within walking distance of office. Please reply to 150 amkoles@pris.ca
TORONTO, ON BUSY DOWNTOWN FAMILY DENTAL CLINIC IS LOOKING FOR AN EXPERIENCED DENTIST, ORTHODONTIST AND PERIODONTIST. PLEASE EMAIL YOUR RESUME TO davidkourosh@hotmail.com
150
KELOWNA, BC FULL TIME ASSOCIATE Seeking highly motivated and experienced individual. Candidate must be compassionate, dedicated to patient care with strong communication skills. Please reply with resume to 150 artworkmat23@gmail.com
THUNDER BAY, ON Full time associate position available in a busy dental office in Thunder Bay, Ontario. Well established patient base, flexible work hours and schedule. Please forward resume to 150 ashibonn@hotmail.com NORTHERN ONTARIO ORTHODONTIST Well-established orthodontic practice in northern Ontario seeking a dynamic, motivated Orthodontist to join our team. Excellent compensation. Mentorship available. 150 E-mail: cristina@dentalservicecorp.com
THOMPSON, MB ASSOCIATE – NEEDED IMMEDIATELY!! Full-time, energetic, detail oriented associate needed immediately for established, busy family practice with high income potential per month. Enjoy a fully booked schedule and ability to reach your goals as a dental professional. Experience preferred. Excellent opportunity. New grads welcome. Living accommodations provided. E-mail cv: thompsondent@gmail.com 150 P: 204-939-0083.
150
ASSOCIATE DENTIST – SAULT STE. MARIE What does it take to succeed as a dentist at Northern Dental Care? We are currently seeking a dentist who embraces continual learning and self-improvement. Excellent communication and customer service skills are a must. Our practice focuses on comprehensive diagnosis and treatment plans and we offer a complete range of treatment options in-house. We have a newly expanded, 7500 square foot facility with digital radiography, computerized charts, a highly trained team, and the best working environment for the best people to work. This is an excellent opportunity to grow your skills quickly and learn from experienced dentists in a top 1% practice. With our highly skilled support team and coaching you can learn how to fast-track your way to success in your first year with us that would take the average dentist a decade to reach. Compassion, strong ethical conviction and positive attitude will ensure a good fit with our vision. Sault Ste. Marie offers a low-stress lifestyle and immediate access to outdoor activities of all kinds – a quality of life that you will not find anywhere else. Send CV to ashlee@northerndentalcare.com www.oralhealthgroup.com
BROCKVILLE, ON
REGINA, SK
Associate needed in a busy modern dental practice located in the beautiful 1000 islands. Please send resumes to: 150 drvijaybhatt@gmail.com
Periodontal Associate Opportunity Satellite or ownership opportunity would also be considered. Please contact Terri – 150 aligncc@outlook.com
SHEPPARD AND LESLIE – TORONTO, ON Looking for an associate to fill a full time position. Ideal candidate to have a good command of the English language and great communication skills to engage our patient base. North American training and a minimum of 5 years experience on a broad base of dentistry preferred. Please forward your resume for consideration to e-mail: 150 resume.dental@rogers.com
100 MILE HOUSE, BC Looking for F/T friendly, outgoing associate to join our team. Well established 30+ yr, busy family practice located in the central interior of BC (100 Mile House). We have a large patient base and perform most aspects of dentistry. Dentist is looking to work less and there is also buy in potential. E-mail: drbeaton@shaw.ca 150 or tel: 250-395-2522.
MISSISSAUGA, ON Established Mississauga dental practice is seeking a part-time associate to join our team and replace an associate that left this past year. Opportunity to grow into a full time position in the future. Candidate must speak English fluently and have at least one year experience in general practice.
Please send resume to info@willowdental.com
150
OTTAWA, ON Associate needed for our busy and growing practice. We can offer either a part-time (3 days) or full-time job. Weekends and evenings will be required from the associate. Mentorship program available for new grads. Opportunity to make up to 43% for the right candidate. Please email your resume to 150 ottawadentistrycareer@gmail.com
www.oralhealthgroup.com
BOLTON, ON A well established, family oriented dental practice in Bolton is looking for a kind, caring, compassionate and passionate associate. The successful candidate will be offered Mondays, Tuesdays and alternate Saturdays as well in the near future Thursdays will be added. Candidates must have completed at least two years of dental education in North America. Please forward resume to recruiting@tmfd.ca
150
SARNIA AND OWEN SOUND, ON Full Time Associates Needed Excellent opportunities in progressive, busy, modern family practices. Above average remuneration for the right practitioner. Candidates need be capable and competent, dedicated to excellent and compassionate care and be personally and professionally responsible. Working some evenings and Saturdays is a requirement. Positions available in Sarnia and Owen Sound Ontario. Please apply in confidence to 150 drtimpringle@bell.net
TORONTO, ON Associate needed for Sept. New practice in dense residential area at Kennedy and 401. Only dental office in the enclave. Fantastic opportunity for new grads or 1-2 yrs exp. Interested candidates email resumes to 150 scarbdoc125@gmail.com
RED DEER, AB Our progressive office is seeking a full time associate. Candidate must be personable and willing to work in a team environment. Practice offers all aspects of general dentistry, including orthodontics and implantology. Great patient base with excellent new patient flow. Modern technology with 6 ops. 150 Please email: caddsopp@gmail.com
TORONTO, ON Associate required. Dentist required for 2 days a week, for basic restorative, and endodontic treatments. Must speak fluent English and be gentle and friendly. Call 416-233-9454 or 150 email info@nu-mouth.com
DENTAL MARKETPLACE
ASSOCIATESHIPS
MID VANCOUVER ISLAND, BC Associate required for very busy practice in Mid Vancouver Island. Full time associate needed to join very busy, growing, general dental practice in beautiful Mid Vancouver Island. Ideal candidate is an experienced clinician, caring, conscientious and competent in all aspects of general dentistry. Please reply via email to: 150 islandassociate2@shaw.ca
REGINA, SK Seeking motivated and dynamic Associate for long-term, full-time position in a moderately paced, growing, modern and well-appointed clinic. Paid on PRODUCTION! New grads welcome, mentoring available. 150 Please email: admin@courtsidedental.ca
NORTH SCARBOROUGH, ON! Busy dental office in north Scarborough is looking for a FT/ PT dental associate. Saturdays and weekdays available. Canadian graduate is preferred. Chinese speaking a must. E-mail: dentistassociates@gmail.com
150
PETERBOROUGH/ KAWARTHA AREA, ON Full-Time and Part-Time Associates in busy Peterborough and Kawartha area offices. Guarantee Minimum Income. Commutable from GTA but will help with relocation if needed. Paperless charting, Digital X-rays, Modern Facility. Fewer than 1 % patients under OW/ODSP. Experience an asset but not essential. Email: Kawartha-Peterborough- 150 Dentist@outlook.com
WEST OTTAWA, ON ASSOCIATE OPPORTUNITY Seeking full-time/part-time associate to join a well established family practice. We provide a complete range of services and candidate must be passionate and conscientious about patient care, patient experience and excellence. Great opportunity for growth. Email: dental_employment@hotmail.ca
150
September 2017
37
DENTAL MARKETPLACE
ASSOCIATESHIPS OWEN SOUND, BRANTFORD AND GTA, ON General dentist and Orthodontist needed for Owen Sound, Brantford, and other locations throughout the GTA. E-mail: 150 yourdentaldream@gmail.com
HAMILTON, ON P/T leading to F/T GP Associate Needed. Must be patient-oriented with caring mind and great with children. Mondays/Saturdays (more priority) and Wednesdays. Please send your resume to 150 WEDMAIN@HOTMAIL.COM
E-mail: narcher@drarcher.ca
TORONTO, ON
EDMONTON, AB
VERNON, BC
ORTHODODNTIST REQUIRED 2 -3 days per month in our clinic at North York location . Please send your resume to: 150 smile@northyorkdentalclinic.com
Very busy south side practice looking for an endodontist to work in office. All endo is referred, possibility of referrals from other dentists as well. Please forward resume to: 150 swongus@shaw.ca
F/T associate required for established, busy practice in beautiful Vernon B.C. New grads welcome. All aspects of dentistry practiced, incl: implant. Op offered to candidate who displays patient centered care, clinical proficiency & desire for continued education. Ideally enjoys all aspects of general dentistry, incl: oral surgery, pedo, crown/bridge & endo. Send resume to 150 jim.belot@telus.net
OTTAWA, ON
BURLINGTON, ON Exciting Opportunity for Experienced Dentist!!!
Established and thriving Burlington practice looking for the right ‘fit’ with a part-time to full time associate. If you are DRIVEN, PASSIONATE ABOUT DENTISTRY and interested in growing and establishing a consistent patient load, we would love to hear from you! Please respond to 150 1stdentalteam @gmail.com
Full time Associate Seeking highly motivated and experienced individual. Candidate must be compassionate, dedicated to patient care with strong communication skills. Possibility of future partnership or buy in potential available for the right candidate. Please reply to 150 ottawadentalgroup@gmail.com
ABUNDANT OPPORTUNITIES IN THE SOUTH GENERAL DENTISTS NEEDED – EXPERIENCED PREFERRED HOWEVER NEW GRADS ARE ENCOURAGED TO APPLY
ABLE DENTAL GROUP Jump start your career with us… Associate or Buy-In Opportunities for the Right Candidate Exciting career opportunities are awaiting you in sunny southern Alberta. We are looking for motivated individuals to join our team of dental professionals who use “big city technology”, yet serving the needs of our community and surrounding areas. The Group has always been one step ahead of the rest to take advantage of new technology and “looking outside of the box” attitude and ideas. We share this enthusiasm with our Associates and Staff, and we pride our company’s success on teamwork and providing a team environment. Visit our website to get an insight on who we are… www.abledentalgroup.com Please contact our office to arrange an on-site meeting and viewing Shari Mead, Office Manager 403-715-5069 150 shari@abledentalgroup.com
38
TORONTO, ON Toronto GP office seeking Pediatric DDS and GP’s who love kids. 1 day a month or 1/2 day a month; 3 locations.
4FQUFNCFS 2017
NORTHERN ONTARIO Want to get away from the city and enjoy the simple pleasures of life? If the outdoors, fishing, water activities, and laid back lifestyle are what you desire, this is the opportunity of a lifetime for the right candidate. Picturesque Northern Ontario gold mine town looking for a part time or full time associate to replace retiring associate in busy well established dental office (30+ years). Office does have access to OR hospital privileges. Paperless practice with high tech gadgets. New Grads welcome. Permanent position with many opportunities. Please fax resume to 807-274-1738 150 Call: 807-276-1013 E-mail: dr.mikewu@gmail.com
AD INDEX Clinical Research Dental . . . . . . . . . . . . . . . . . . . . . . . . 17 Crest Oral-B, P&G . . . . . . . . . . . . . . . . . . . . . . . . . . 7, 13 GC America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 GSK – GlaxoSmithKline . . . . . . . . . . . . . . . . . . . . . . 4, IBC McCaughey Consumer Products Management . . . . . . 32 Oral Science . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Philips Oral Healthcare . . . . . . . . . . . . . . . . . . . . . . . . IFC Premier Dental Products Company . . . . . . . . . . . . . . . . 14 SciCan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9, 21 Shofu Dental Corporation . . . . . . . . . . . . . . . . . . . . . . . 27 TD Canada Trust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 VOCO Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OBC Waterpik . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Xlear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
www.oralhealthgroup.com
SHE KNOWS THAT STRAWBERRIES HAVE A HIGH ANTIOXIDANT CAPACITY. WHAT ELSE WOULD SHE WANT TO KNOW? Young people today are staying informed to stay healthy.1 But do they know that healthy foods including fruit, juices and sports drinks are highly acidic and can put their enamel at risk?2-5 Exercise your influence as their trusted dental professional. Help educate every young patient about the effects of acid erosion. Because the investment in their enamel should start today.
For your acid erosion candidate. 1. GSK data on file, 2013. 2. Lussi A. Erosive tooth wear – a multifactorial condition. In: Lussi A, editor. Dental Erosion – from Diagnosis to Therapy. Karger, Basel, 2006. 3. Lussi A. Eur J Oral Sci. 1996;104:191–198. 4. Hara AT, et al. Caries Research. 2009;43:57–63. 5. Lussi A, et al. Caries Research. 2004;38(suppl 1):34–44.
TM/® or licensed GlaxoSmithKline Consumer Healthcare Inc. Mississauga, Ontario L5N 6L4 ©2017 The GSK group of companies. All rights reserved.
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Plusieurs l’ignorent . Elles peuvent aussi en ignorer les conséquences sur leur santé buccodentaire*. Elles attendent vos conseils.
La bouche sèche est un problème de santé buccodentaire qui affecte surtout les personnes prenant plusieurs médicaments3. Pourtant, certaines personnes qui souffrent de bouche sèche ne savent pas qu’il s’agit d’un problème courant2. Parlez à vos patients de la bouche sèche et du soulagement que Biotène peut aider à procurer†. ®
www.biotene.ca
GlaxoSmithKline Soins de santé aux consommateurs Inc. Mississauga, Ontario L5N 6L4 © 2017 Le groupe d’entreprises GSK ou son concédant. Tous droits réservés. * La bouche sèche peut perturber l’environnement de santé buccodentaire et causer la mauvaise haleine, la déminéralisation et l’augmentation de la carie4,5. † Rince-bouche, gel et vaporisateur. ‡ Tel que mesuré dans le cadre d’une étude clinique de 28 jours6. 1. Données internes de GSK. Occasion de croissance de Biotène pour la bouche sèche (incluant les données U&A canadiennes). 16 juillet 2014. 2. Dawes C. How much saliva is enough for avoidance of xerostomia? Caries Res. 2004;38:236-240. 3. Sreebny LM, Schwartz SS. A reference guide to drugs and dry mouth, 2e édition. Gerodontology. 1997;14:33–47. 4. Turner MD, Ship JA. Dry mouth and its effects on the oral health of elderly people. J Am Dent Assoc. 2007;138:15S–20S. 5. Fox PC. J Clin Dent. 2006;17 (numéro spécial):27-28. 6. Données internes de GSK 2014, RH01986.
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ELLE SAIT QUE LES FRAISES COMPORTENT D’EXCELLENTES PROPRIÉTÉS ANTIOXYDANTES. QUE DEVRAIT-ELLE SAVOIR DE PLUS? De nos jours, les jeunes se tiennent au courant pour vivre sainement1. Mais savent-ils que les aliments sains, comme les fruits, le jus et les boissons pour sportifs, sont très acides et qu’ils peuvent mettre leur émail à risque2-5? Usez de votre influence en tant que professionnel dentaire de confiance. Informez chaque jeune patient des effets de l’érosion par acide. Ils doivent investir dans leur émail dès aujourd’hui.
Pour vos patients prédisposés à l’érosion par acide. 1. Données internes de GSK, 2013. 2. Lussi A. Erosive tooth wear – a multifactorial condition. Dans : Lussi A, directeur. Dental Erosion – from Diagnosis to Therapy. Karger, Basel, 2006. 3. Lussi A. Eur J Oral Sci. 1996;104:191-198. 4. Hara AT et al. Caries Research. 2009;43:57-63. 5. Lussi A, et al. Caries Research. 2004;38(suppl. 1):34-44.
MC/® ou sous licence GlaxoSmithKline Soins de santé aux consommateurs Inc. Mississauga, Ontario L5N 6L4 ©2017 Le groupe d’entreprises GSK. Tous droits réservés.
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