Open Wide - The Official Blog of The Chicago Dental Society

Permanent link  High tech caries detection: Our interview with Midwinter speaker Dr. John Flucke


At the age of three, Dr. John Flucke performed his first extraction (on his older sister's loose tooth) and immediately thereafter announced to his mother that he was going to be a dentist. He now has a practice in Lee's Summit, MO, and is clearly passionate about what he does. He writes a new post for his Dental Technology Blog nearly every day and is also known as dentistry's "Technology Evangelist." He will be teaching the course "Advanced Digital Caries Detection" at the Midwinter Meeting. You can also follow Dr. Flucke at his Twitter account, @jflucke.

Q: What drew you to the topic of advanced digital caries detection?

Dr. John Flucke:
I've always been a "why" person. Why we do the things we do and how we can do them better fascinates me. Caries detection is intrinsically part of dentistry so I really wanted to become familiar with the new devices and why they can help.

Q: What will this course look like?

JF: It's a lecture format that goes over the devices that are currently available.

Q: In your opinion, what is the best or most effective caries detection device on the market today?

My answer to that would be "it depends." All of them are accurate and provide valuable data. The choice really comes down to how a practice operates. In a fast-paced, high patient-turnover practice, some devices will be better suited than others.

Q: What are the best new treatments for dental decay?

JF: Minimally invasive/more conservative treatment modalities are definitely the way to go if the situation will allow it. Self-etching resins are now a reality and other changes are coming that will allow us to minimally restore with ease.

Q: What do you think are the biggest deficiencies in most dental offices with regards to caries detection?

JF: Many people feel that finding caries can be done just as easily with traditional methods and that is just not the case. I've had people tell me that they are just fine with an explorer. It's all about educating doctors and then helping our patients.

Q: How many times have you been to the Midwinter Meeting?

JF: Wow, I think every year since 1996 or so.

Q: What's your advice for visiting Chicago in February?

JF: Bring something to cover your ears! One year I didn't do that and looked like an idiot as I ran around the city with my gloved hands pressed to the side of my head! Seriously, don't let the cold deter you. Chicago is one of the best cities in the world for a reason. You've got to get out there and explore it!

Q: Do you have any tips or tricks for navigating the Meeting?

JF: If you know you are looking for certain things, make a list and then get a map of the show floor and map out your route. Also, the second day on the show floor is not usually as busy as the first day.

Q: Do you defy any "dentist stereotypes"? Can you share any other fun personal facts?

JF: I'm a combination geek/dentist personality type. I'm completely process driven and I've been known to drive people crazy asking questions about how/why things work the way they do. I don't sleep much and I always take off my left shoe first.


rachel zanders , midwinter meeting 2010 ,

Permanent link  Non extreme smile makeovers: Our interview with Midwinter speaker Dr. Harald Heymann


Dr. Harald Heymann, Professor and Director of Graduate Operative Dentistry at University of North Carolina's School of Dentistry, is an outdoorsman who is passionate about using the most conservative possible methods when performing esthetic dentistry. He will be presenting the course "Non-extreme Esthetic Makeovers Possible," as well as "Adhesive and Restorative Dentistry: Fact and Fiction," at the Midwinter Meeting.

Q: What drew you to the topic of non-extreme esthetic makeovers, and why are you teaching this course?

Dr. Harald Heymann: I think that there's a lot of overtreatment. I try to stress doing as little as possible and yet achieve the goal of improved esthetics. It is important to combine the most conservative methods possible to achieve the desired results.

Q: What will this course look like?

HH: It's a lecture course, and I'll be addressing various whitening methods, from whitening toothpastes to over-the-counter products to in-office products. I'll spend a fair amount of time on how to place etched porcelain veneers. I'll focus on long-term success-the bonds to enamel are so superior to those to dentin. What I present will not be based on anecdote, opinion, and hype, but on good, evidence-based information.

Q: Which procedures are you most discouraging?

HH: Over-treatment and over-preparation of teeth.

Q: What do you think is the dentist's role in guiding a patient when making these decisions?

HH: The dentist should inform the patient of the most conservative options possible. For instance, simple tooth whitening or orthodontia instead of something more extreme. It is the dentist's responsibility to provide the various options and then guide the patient to the most conservative option that will achieve the desired effect.

Q: How many times have you been to the Midwinter Meeting?

HH: Oh gosh, a bunch! I've been teaching now for 32 years, so I've been coming to the meeting in various capacities for a long time. In fact, I believe this is one of the best in the country, no question.

Q: What's your advice for visiting Chicago in February?

HH: Dress warmly! And keep an eye on the weather. I've had overnight trips to the Meeting turn into three- and four-day trips due to unanticipated snow.  So I'd also have to say, be flexible!

Q: Do you have any tips or tricks for navigating the meeting?

HH: I understand they're now going to be concentrating the meeting on the west side of McCormick, and that should really help as far as finding courses, etc.

Q: What do you like to do in your spare time?

HH: Well, I live for the outdoors - skiing, fly fishing, hiking, outdoor photography. I really enjoy just about anything that gets me outside.


rachel zanders , midwinter meeting 2010 ,

Permanent link  Infection control in the dental office: Our interview with Midwinter speaker Dr. John Molinari


John Molinari, Ph.D., author, lecturer, husband to a pediatric dentist, and father of seven, will be presenting the lecture "Respiratory Infections, Protection" at the Midwinter Meeting, along "Infection Control" and "Vaccination Recommendations for Healthcare Professionals." With current concerns about H1N1, his topic is timely.

Q: What drew you to the topic of respiratory infections in the dental office?

Dr. John Molinari: I've been a microbiologist in infectious diseases for many years. Respiratory infections are the most transmissible, and people in the dental profession are exposed to respiratory infections very routinely. A dentist wears a mask while he or she is working, but there are so many other opportunities for infection to be passed. There's a logical bond here with the professional exposure.

Q: What airborne infection causes the greatest concern for dentists this season?

JM: The flu. Both seasonal and H1N1, which has been around since April. Any pandemic strain of influenza, which crop up every few years, is more virulent. Everyone needs to be aware of the principles of normal infection.

Q: Which are the approaches to protection that dentists' offices can take that you'll be talking about in your lecture?

JM: Well, we're not just talking about the flu here, but also TB, Pertussis or the whooping cough. These are all easily transmitted. I'll be talking about how they are passed and how they work. Some of the preventative steps are, of course, vaccinations and hand washing. For dentists, masks are good. I'll be talking about he alternative use of alcohol hand rubs that everyone's carrying around in their purses and pockets these days.

But I'll also be talking about what the influenza vaccine is all about and why you need a new one each year. I'll be talking about how the vaccines are prepared, and I'll be clearing up a huge misunderstanding: You cannot get the flu from the vaccine. People hear the stories from their neighbors and their grandmothers and are afraid the vaccine will give them the flu. I had to go to extraordinary effort to convince my own mother to get the vaccine this year! She had heard from so many people that it could give you the flu--but who's the microbiologist here?

In any case, I'll be giving the people in my lecture the science and the background behind it. By the time they're finished, they're allies. They're junior microbiologists who can talk to their patients about this. People will believe what a dental hygienist or dentist tells them because they see them, they're familiar and comfortable.

I'll also be talking about TB and whooping cough as an emerging issue. When's the last time people thought about the whooping cough? We used to see this as something you were vaccinated against and never had to think of again. But we're seeing it in more adolescents and adults, and we're finding that the vaccine doesn't protect as long as they thought it did.

Q: How long have you been in the field of microbiology?

JM: I've been in the field for 44 years, including research, teaching, and as a clinical microbiologist. And I have not just focused on respiratory infections. I've researched and worked with AIDS, cancer, you name it. You have to have the clinical expertise to go along with the science.

Q: How many of these Midwinter Meetings have you attended? Do you have any tips or tricks for navigating the Meeting?

JM: I come every other year, and sometimes every year. There are just so many courses that are very, very good. If you're with other people, you'll have to split up and compare notes. It's such a traditionally good meeting as far as courses, you can't possibly see everything you want to see. And the exhibits are among the most extensive. You have to be prepared to spend a full few days there.

Q: What's your advice for visiting Chicago in February?

JM: Dress warmly! We've had everything from rain to snow to sleet.… I won't say we've had warm weather! If you want good food or entertainment in the city, you have your pick. And of course the shopping if you're into that. Chicago really has everything you could want … except the warm weather!

Q: Are you doing anything unusual over the holidays?

JM: Well, we have seven children. Three of our daughters are out of the house, and the last three are our thirteen-year-old triplets, and our oldest still at home is sixteen, so with four teenagers in the house, you can imagine! We'll be diving down to visit our families for the holidays--mine are in North Carolina and my wife Gail's are in Georgia. For Thanksgiving, with the older girls and grandchildren, we'll have sixteen family members along with four neighbors, so twenty people at the Thanksgiving table!


h1n1 , midwinter meeting 2010 , rachel zanders ,

Permanent link  Are you ready for a medical emergency? Our interview with Midwinter speaker Dr. Stanley Malamed


Dr. Stanley F. Malamed, professor of Anesthesia and Medicine at University of Southern California's School of Dentistry actually hopes it snows in Chicago during the Midwinter Meeting! He'll be teaching two courses, "Is Your Practice Ready for a Medical Emergency?" and "The Renaissance of Local Anesthesia."

This transcript is edited from an e-mail exchange that took place in November 2009.

Q: What drew you to the topic of medical emergencies in the dental office?

Dr. Stanley F. Malamed: I am a dentist anesthesiologist, a member of a small group--several hundred in the U.S.--of dentists who have completed an anesthesiology residency. Given that background, and being in an academic environment, one of the subjects that is closely associated to anesthesia is emergency medicine--essentially how to keep a person alive, which is what anesthesiologists do on a daily basis.

Q: Are there any recent events that make this a particularly important topic today?

SFM: On a regular basis we hear, through the media, of "disasters" that occur in the dental office. In Chicago in 2007 the principal of an elementary school died in a dental office while having root canal treatment. It made the national press. Unfortunately, when a person dies in a dental office, it comes as a surprise to non-dental people, who make up most of the world. Yes, unfortunately this does happen, albeit rarely.

Q: What are the most common medical emergencies that occur in dental offices?

SFM: Syncope, or fainting, is far and away number one, accounting for about 50 percent of the emergencies we see. Other common emergency situations include mild allergy, anginal chest pain, seizures, asthmatic attacks, and low blood sugar.

Q: Which emergencies do you think dental offices are least prepared to handle?

SFM: From surveys I have done asking doctors about their level of confidence in recognizing and managing specific emergency situations, the lowest levels of confidence occur with local anesthetic overdose, sedative overdose, and bronchospasm, or acute asthmatic attack.

Q: What is the number-one preventative step you will be discussing?

SFM: Knowing your patient-medical history, monitoring vital signs, knowing when not to treat. Having said that, about 75 percent of all medical emergencies seen in dentistry are preventable; however 25 percent are not. Stuff still happens.

Q: Do you have any anecdotes relating to emergency medicine?

SFM: At the Hinman Dental Meeting about four years ago, as I was walking into the Georgia World Congress Center to give a talk on medical emergencies, a man walking about 20 feet in front of me collapsed on the ground in cardiac arrest. Helping the paramedics, I ventilated, and the man survived. A memorable way to start a lecture on medical emergencies.

Q: You're coming from sunny southern California! How do you feel about visiting Chicago in February?

SFM: I love coming to the Midwinter in February. It's my four or five days of winter. I hope every year that it snows and is really cold. I like to run in the park in the snow … knowing that in three or four days I'll be able to return to L.A. and run in the nice warm "winter" weather at about 60 to 80 degrees.

Q: Would you be willing to share any anecdotes about your early experiences as a dentist?

SFM: Two anecdotes about my early experience as a dentist, before I became the "famous" Dr. Malamed, the expert on local anesthesia as well as emergency medicine:

Taking my state board examination in NY in 1969, a very good friend of mine was the patient. After getting an OK to start, I pulled out a local anesthetic syringe and proceeded to stick the needle right through his lower lip! We both started laughing, which broke the tension of the exam and I then proceeded to successfully pass it. Happily the examiner never found out!

Another story: While in my anesthesia residency, my wife was to have her four third molars extracted by a rather prominent oral surgeon. He asked me to help him by simply getting her "numb." Needless to say I missed all four teeth!

About ten years later while I (by now an "expert" on local anesthesia) was giving a lecture on "How to Teach Local Anesthesia to Dental Students," a hand went up in the audience. The question, from the oral surgeon mentioned above, was "Would you tell the audience about the day I asked you to get your wife numb?" It was humbling.


rachel zanders , midwinter meeting 2010 ,

Permanent link  Managing your online reputation: responding to negative comments online


Please welcome Rachel Zanders, a writer who will be posting to this blog from time to time. Rachel is also a contributor toGapers Block, where she covers Chicago's dance community.

This is the third and final installment in a series of articles on how dentists can protect and manage their reputation online. 

Now that you've learned a little about review websites and search engines, and now that you've established and researched your online presence, what can (and can't) you do about what all of those real people are saying about you?

First, try getting to the client before the client gets to the keyboard. Asking the patient about his experience in your office before he leaves might diffuse his desire to vent, or it might be the extra effort that encourages him to go tell the world about your polite and caring office. And of course, he might present you with some thoughtful feedback that you can act upon.

Next, utilize the online tools to your fullest advantage by staying vigilant (potentially with the aid of Google Alerts, as suggested in the previous post) and taking action when you find something that merits it. If you receive a review--either positive or negative--on a site like Yelp that allows you to reply, consider using that tool. (The tips provided in Yelp's thorough guide to responding to reviews could be applied to a business response on any similar website.) However, as a healthcare professional, you must tread carefully because of HIPAA.

Dr. Petra von Heimburg, P.C., dentist, attorney, and CDS member, points out that the gut reaction to respond in a public forum, "explaining the circumstances, [the] treatment, and laying out the reasons therefore, … often leads to HIPAA violations by the dentist because, while mounting his defense, he will invariably reveal details of the patient's protected information." When in doubt, reply privately or don't reply at all, and always tread carefully.

And finally, what to do if a client posts something defamatory? The hope is that you can find a way to work it out privately with the reviewer. But many sites won't release a reviewer's information without "a court order or a formal demand by another legal authority" (Dr. Oogle), and most will not remove comments. It's certainly worth asking the site to withdraw the comment, stating your solid reasoning, but don't be surprised if the site does not find in your favor. (Yelp's CEO Jeremy Stoppelman has been quoted as saying, "We put the community first, the consumer second and businesses third.")

If all of those efforts fail, you might start thinking litigation. After all, there's that semi-success story about the pediatric dentist in San Francisco who is currently attempting to sue the writers of a Yelp review. (See also this article and link.)

But Dr. Heimburg wouldn't advise you to take that route. First, "defamation, be it libel or slander, by definition, has to be a wrongful statement of fact. If the statement is an opinion, it is protected by the First Amendment." Second and third, "a defamation lawsuit is difficult to win … and very expensive," to the tune of "$20,000 or more." In order to win the case, first you have to prove there was a false statement of fact.  Then you have to prove that you experienced business loss that was caused by the defamation. And then you have to be able to prove the amount lost. Can you prove that ten potential patients who researched you on Yelp absolutely would have chosen you if not for the negative review? Can you prove that those ten patients would have produced an income of $2,000 each?

But don't lose hope. Your online reputation is not your enemy, and maintaining that reputation is a manageable task. The truly problematic posts should be very rare, and remember that you have innumerable opportunities to harness the power of the new word of mouth and make it work to your advantage.


online reviews , practice management , rachel zanders , reputation , yelp ,