Dental Treatment for Pregnant Patients: What’s Holding Us Back?

Reading time: 11 minutes

A new patient books an emergency appointment at your practice for severe toothache pain. Over the phone, she describes the pain as constant and throbbing to the point of disrupting normal eating and sleeping routines, and the difficulty eating has led to recent weight loss. Your staff works her into the day’s schedule, and she arrives at your office later that afternoon. When she arrives, it is quickly noted that she is 7 ½ months pregnant and in extreme pain and discomfort. How do you proceed?

The Fear Factor

The consequences of not receiving urgent and emergency dental care during pregnancy can be devastating.

Daniel Ninan, DDS
“A few years ago, one of my best friends from childhood was pregnant,” Daniel Ninan, DDS, author of a new book titled Dentistry and the Pregnant Patient (Quintessence, 2018), recalls. “She had a severe toothache, and she could not find a dentist who would treat her. At the same time, the Federally Qualified Health Center I worked at started receiving additional funding to provide dental care to pregnant women who otherwise had no access to care. Because of this, I began seeing more pregnant patients. It quickly became apparent to me that the plight of my friend extended to other pregnant women who were also experiencing pain and suffering. Like my friend, these women also had difficulty finding dentists who would help them.”

A 2008 study found that 90% of dentists did not provide all necessary treatment to pregnant patients; the main reason for this is fear. The same study reported that the reasons dentists gave for withholding or delaying treatment until after pregnancy included fear of injuring the woman and fetus and fear of subsequent litigation.

The four categories of dental treatment for pregnant patients as described in Dr Ninan’s book. (Click image to view larger.)

“When I first started practicing dentistry, I noticed significant reluctance among my colleagues in providing dental care to pregnant patients,” Dr Ninan explains. “In the dental literature, there is at least one case of litigation regarding dental treatment and an adverse pregnancy outcome. During a patient’s third trimester, a dentist removed the patient’s wisdom teeth. The fetus later was stillborn, and both the obstetrician and the dentist were sued. The courts dismissed the case against the doctors, but the risk is real. Fortunately, my understanding is that there have been very few malpractice suits filed against dentists with regard to providing or withholding dental care for pregnant patients. Clinically, it is generally very difficult to link a pregnancy outcome with a specific dental procedure or treatment that occurred once during the pregnancy.

“One very important piece of this,” he continues, “is the patient’s perception of the safety of dental treatment during pregnancy. It’s important to ascertain the patient’s emotional bias toward the benefit or harm in providing dental treatment. This is because there is always a risk of adverse pregnancy outcomes. And even in the absence of supporting scientific data, the patient may come to the conclusion that the dental care provided—or withheld—is what caused her to have an adverse pregnancy outcome.”

While litigation may serve as a concrete assignment of blame on the dentist, most dentists are equally afraid of causing harm to the patient, her unborn child, or both. Only recently has scientific research begun on the safety and ramifications of dental treatment during the different stages of pregnancy, and that research is nowhere near comprehensive yet.

“I think perhaps one of the biggest fears is simply not knowing the safest way to proceed,” Dr Ninan emphasizes. “And intertwined with this is the fact that modern medicine allows women to be pregnant while having more complex medical conditions and while on more medications than in the past. Because of this, some of the women who are pregnant today are more medically compromised than in the past.

Emergency and urgent dental care should be provided at any time during pregnancy.

“Researchers are often observing the absence of adverse outcomes when providing dental treatment during research,” Dr Ninan continues, “but it is important to keep in mind that the absence of an observed adverse outcome doesn’t necessarily mean dental treatment is safe. However, it does suggest that necessary dental treatment might be okay to provide. It is also important to keep in mind that even though dental treatment is often safely provided, dental treatment itself is never completely safe, whether the patient is pregnant or not. There is always a myriad of very small risks that we are seeking to minimize. Some examples of these risks include allergic reactions, aspiration of dental material, and other procedural complications. So one question to consider is in the event there is a complication, when is the preferred time to manage the complication: during pregnancy or after pregnancy? This is why I generally suggest focusing on necessary treatment that improves the patient’s health during pregnancy and deferring any elective treatment until after pregnancy. In general, the safest option is to defer dental treatment until after pregnancy, when there is no fetal risk. However, emergency and urgent dental care should be provided at any time during pregnancy. Examples include providing care for acute infections and abscesses. If treatment is necessary, give consideration to both the type of treatment and the phase of pregnancy.”

Table 2-1 from Dr Ninan’s book showing a summary of dental treatment recommendations during a normal pregnancy. (Click image to view larger.)

A Circular Problem

But dentists aren’t the only ones responsible for a woman’s oral health during pregnancy. Even as more research surfaces to support both the negative effects oral pathologies can have on a pregnancy and the benefits of a healthy mouth during pregnancy, studies have found that most women are not advised by their prenatal care provider to see a dentist.

“Most women don’t see a dentist at all during their pregnancy, but the consequences of not receiving urgent and emergency dental care can be devastating,” Dr Ninan states. “In a 2012 study, it was reported that obstetricians were well informed on the relationship between periodontal disease and pregnancy outcomes. However, at the same time, many prenatal general practitioners and midwives may not understand the link between oral health and overall health. The authors of the study also found that most of the time, prenatal care providers did not discuss oral health with their patients and dental referrals were often only made when the patient self-identified an oral health problem. Another study found that only 26% of women were advised by their prenatal care provider to see a dentist. While there has been an improvement in recent years on awareness of how oral health may affect pregnancy, this has not translated to a greater number of dental referrals from prenatal providers.”

This awareness also hasn’t translated to greater awareness among pregnant patients of the need for dental care. “In the United States,” Dr Ninan explains, “only 25% to 50% of women will receive any dental care while pregnant, including prophylaxis. This is true even though 50% of pregnant women have dental problems. Pregnant women do not seek dental care during pregnancy for several reasons: They may not realize they have an oral disease, they may believe poor oral health is normal during pregnancy or that dental treatment may harm the fetus, or they are just not informed that they should seek care. Patients often look to their health care providers to know what is or isn’t safe, and I predict that patients will naturally seek care that is necessary to improve their health if it’s recommended by health care professionals. I think this can be simplified down to the idea that perhaps one of the best things we can do for the fetus is to help the woman be in a state of optimal health.”

The Silent Barrier

Another far more complicated issue is that of patient access to dental care. A 2008 study found that while 84% of patients believed dental treatment during pregnancy was safe, only 44% of those patients received dental care. The main limitation reported was financial access.

One of the best things we can do for the fetus is to help the woman be in a state of optimal health.

Unlike dental benefits for children, which are mandated by the Affordable Care Act, adult dental benefits remain optional even under Medicaid. According to the Medicaid website, states have the ability to choose whether to provide dental benefits for adult Medicaid enrollees. Most states provide at least emergency dental services for adults, but less than half of the states currently provide comprehensive dental care. Some states, including California where Dr Ninan practices, also offer dental services for pregnant woman in addition to the federally mandated coverage for children.

“Pregnancy may be the only time women in the lower socioeconomic strata are eligible for dental benefits,” Dr Ninan states. “But because adult dental benefits are optional under the Affordable Care Act, whenever states who provide them run low on money, those benefits could be eliminated. One example is when California cut adult dental benefits for nearly a decade.”

In 2009, California slashed its adult dental program, Denti-Cal, in response to the state’s budget deficit. An analysis by the California Health Care Foundation of the program’s performance in 2007, completed in 2010 after the program was largely defunded, provides important data. According to the study, only one in seven pregnant women covered by the program in 2007 actually visited a dentist. The study also identified dental provider reimbursement rates as a major problem affecting the program: Reimbursement rates through Denti-Cal program were much lower than both the national Medicaid averages and the fees dentists receive from commercial insurance, and in 2007 only 24% of California’s private dentists accepted Denti-Cal.

“As of 2018, Denti-Cal has been fully restored or funded,” Dr Ninan says. “However, because of the low reimbursement, it is still difficult to find general dentists and specialists who will accept it. Only time will tell whether the program can overcome these hurdles—and how long California will continue to fund it.”

While care providers may have little control over the reimbursement rates and budget constraints that affect this and similar government programs, they can be the voice to advocate for this patient need to be met.

The Role of Information

But what is the driving factor toward this recent interest in better oral care for pregnant patients? The answer is the desire for evidence-based care. As more evidence is found that shows the connection between periodontal disease and pregnancy outcomes, more dentists and prenatal care providers are beginning to acknowledge the need for oral care for pregnant patients.

“Perceptions of the safety of dental treatment during pregnancy by patients, dental providers, and prenatal providers all contribute to the lack of oral health care during pregnancy,” Dr Ninan explains. “Over time, I’ve noticed a shift in perspective on the part of health care providers. As researchers uncover more evidence linking oral and systemic health and also evidence of the potential impact oral health has on pregnancy, I have seen health care provider professional organizations start advocating for evidence-based care. For example, the American College of Obstetricians and Gynecologists has released a committee opinion in support of the benefits that oral health care can have for the pregnant patient. Organizations such as the American Academy of Periodontology, the New York State Department of Health, and the California Dental Association Foundation have also released practical guidelines for care providers.

“I suspect,” Dr Ninan continues, “that all health care providers have had some education about providing treatment during pregnancy. What I think is lacking are the details of where to get up-to-date information. I also suspect there is gap in time between when they learned how to treat a pregnant patient and when they are first confronted with the need to treat a pregnant patient. They know the general concepts, but they don’t know the details. I still remember seeing my first pregnant patient. I was still in dental school and had just had a lecture that included the topic. I was still nervous, so I actually went to the instructor who taught the local anesthesia course and double-checked that my lecture notes were indeed accurate. I suspect that it’s a similar lack of knowledge that creates the fear of causing harm, even among more experienced care providers. I believe that more information is a critical piece to solving this problem and that increasing the information available will help to facilitate better treatment.”

It’s this lack of organized information that inspired Dr Ninan to write his book Dentistry and the Pregnant Patient. “When we started seeing more pregnant patients where I was practicing,” he recalls, “I went back and looked at my textbooks from school. They did not have enough information, so I read everything I could find on the subject and quickly became aware of the lack of easily accessible knowledge on how to safely provide dental care to pregnant women. I also couldn’t find a collection of all of the information in one place, so I began collaborating with physicians, nurses, pharmacists, general dentists, periodontists, other authors, independent editors, and others. I synthesized all of the information that I had found on the topic with the goal of creating a single resource that would aid in safer and more effective care. My book is a tool that clinicians can use to quickly refresh their memory on the various details of treating the pregnant dental patient.”

Several example chapters from Dr Ninan’s book showing its value as a clinical reference. Click images to view larger.

Dr Ninan’s book provides detailed information on when and how to provide dental treatment for pregnant patients, including management of complications and administration of drugs and anesthetics, and will no doubt serve as an important knowledge base for clinicians. It also advances the topic of dental treatment during pregnancy by representing another source of information on the safety and efficacy of such treatment. By providing this information in an accessible format, his book may even inspire the next step: a wave of clinicians who are no longer afraid to provide necessary treatment for their patients during pregnancy.


Daniel Ninan, DDS, currently works as a general dentist in San Bernardino, California. He is an assistant professor of dental education services at Loma Linda University School of Dentistry in Loma Linda, California, where he was awarded his Doctor of Dental Surgery degree in 2009. He has coauthored a study in the Journal of Obstetrics, Gynecology, and Neonatal Nursing based on neonatal research conducted at Loma Linda University Medical Center. Dr Ninan was also awarded the SAC Health System’s Provider of the Quarter Award in 2012, and he has served on the Quality Council, Mission Possible Committee, Privacy Board, and FQHC Quality Measures Committee for the SAC Health System. Dr Ninan is active in organized dentistry and has served on the Tri-County Dental Society’s New Dentist Committee and Communication Committee. Before earning his doctoral degree, Dr Ninan completed a Bachelor of Science degree in computer science in 1999 and a Bachelor of Arts degree in biology with honors in 2004, both from California State University, San Bernardino, California.

 

Dentistry and the Pregnant Patient

Daniel Ninan

To err on the side of caution, some dentists may hesitate to perform necessary procedures on pregnant patients. However, good oral health is essential to a healthy pregnancy and can help reduce prenatal complications, including preterm delivery and fetal loss. This book serves as an easy-to-use guide to help dentists of all specialties provide safe, effective care for their patients during pregnancy. The book is broken down into chapters on general treatment guidelines, pregnancy-related conditions in each organ system that may impact care, and the safety of the use of common dental drugs, including anesthetics, during pregnancy. With over 50 quick-reference charts and tables and a breakdown of treatment recommendations by trimester, this book is a must-have for any dental office.

160 pp (softcover); ©2018; ISBN 978-0-86715-779-6 (B7796); US $48 Special preorder price! $40

Posted in Books, Feature, Multidisciplinary, What's New | Tagged , , | 3 Comments

Quintessence Roundup: March

Reading time: 8 minutes

Monthly Special


Pediatric Laser Dentistry: A User’s Guide

Giovanni Olivi, Fred S. Margolis, and Maria Daniela Genovese

This comprehensive text, the first to focus on laser applications in pediatric dentistry, reviews the fundamental principles of laser energy and demonstrates the essential therapeutic steps of laser radiation in conservative pediatric dentistry. Detailed explanations of the unique interactions of laser radiation with dental tissues—with a focus on the differences specific to primary and young permanent teeth—help clinicians take advantage of the many inherent benefits of laser energy, such as selective removal of carious tissue, preservation of healthy mineral structure, disinfection of prepared surfaces, excellent hemostasis, and improved patient comfort and compliance. The predictable clinical protocols for hard and soft tissue applications are detailed step by step with explanations on technique and suggested laser parameters, and the outcomes are illustrated in multiple case studies. This practical guide will inspire pediatric dentists who are new to the laser as well as those experienced in providing laser therapy to adults.

224 pp; 521 illus; ©2011; ISBN 978-0-86715-494-8 (B4948); US $168 Special price! $10

 

New Titles in Books


Dentistry and the Pregnant Patient

Daniel Ninan

To err on the side of caution, some dentists may hesitate to perform necessary procedures on pregnant patients. However, good oral health is essential to a healthy pregnancy and can help reduce prenatal complications, including preterm delivery and fetal loss. This book serves as an easy-to-use guide to help dentists of all specialties provide safe, effective care for their patients during pregnancy. The book is broken down into chapters on general treatment guidelines, pregnancy-related conditions in each organ system that may impact care, and the safety of the use of common dental drugs, including anesthetics, during pregnancy. With over 50 quick-reference charts and tables and a breakdown of treatment recommendations by trimester, this book is a must-have for any dental office.

160 pp (softcover); ©2018; ISBN 978-0-86715-779-6 (B7796); US $48 Special preorder price! $40

 

Clear Aligner Technique

Sandra Tai

Clear aligners are the future of orthodontics, but digital orthodontics evolves so rapidly that it is hard to keep pace. This book approaches clear aligner treatment from a diagnosis and treatment-planning perspective, discussing time-tested orthodontic principles like biomechanics and anchorage and demonstrating how to apply them to orthodontic cases using these appliances. Each chapter explains how to use clear aligners to treat a given malocclusion and teaches clinicians how to program a suitable treatment plan using available software, how to design the digital tooth movements to match the treatment goals, and finally how execute the treatment clinically and finish the case well. This clinical handbook will prepare orthodontists and dental students to exceed patient expectations with the most esthetic orthodontic appliance currently available.

320 pp; 1,344 illus; ©2018; ISBN 978-0-86715-777-2 (B7772); US $218 Special preorder price! $175

 

Waxing for Dental Students

Rowida Abdalla

When dental students are first taught how to wax teeth, they need clear instructions with logical steps and plenty of illustrations. With the omission of any distracting information about dies, crowns, bridges, and occlusion, this concise book is squarely directed to first-year dental students and can be used as a primary laboratory manual. The author covers the basics of wax instrumentation and addition, but the bulk of the book details the steps for waxing incisors, canines, premolars, and molars. Each chapter includes an introductory waxing exercise for the tooth type, followed by the key points of morphology for the tooth in question. Photographs detail the waxing steps for both a maxillary and a mandibular full crown on a tooth peg and show how the wax-up should mimic the contralateral tooth in terms of dimension, embrasures, heights of contour, line angles, and point angles. The logical and straightforward protocols in this book will help dental students quickly improve their waxing skills and reach expected goals.

88 pp (spiral bound); 388 illus; ©2018; ISBN 978-0-86715-773-4 (B7734); Now available! $58

Read more about Waxing for Dental Students here!

Waxing Poetic: The First Waxing Manual Written Specifically for First-Year Dental Students

 

Quintessence of Dental Technology 2018

Edited by Sillas Duarte, Jr

QDT 2018 presents original articles with a beautiful array of images showcasing the year’s newest techniques, materials, tools, and innovations. This year’s focus is decidedly digital—digital treatment planning, digital communication, and digital multidisciplinary workflow for esthetic and functional rehabilitations. Minimally invasive techniques are highlighted throughout, including their use for full-mouth rehabilitation and to restore the morphology of teeth damaged by wear. A special “how-to” article on focus stacking macro photography by Carlos Ayala Paz is the first to be published specific to dentistry.

256 pp; 1,090 illus; ©2018; ISBN 978-0-86715-783-3 (J0629); Now available! $148

 

Esthetic and Restorative Dentistry: Material Selection and Technique, Third Edition

Douglas A. Terry and Willi Geller

Restorative dentistry has seen dramatic advances in recent years, especially with the use of digital technologies, and this book provides the most up-to-date information on enhanced developments, materials, and techniques that have emerged since the publication of the second edition, offering the reader a completely updated, revised, and newly illustrated overview of modern esthetic and restorative dentistry complete with tutorial videos. New topics include web-based communication with the laboratory, indirect composite chairside CAD/CAM restorations, a comparison of digital and conventional techniques, the resin composite injection technique, as well as updated information on composites and ceramic systems, including esthetic zirconia. New cases illustrate the maintenance of esthetic restorative materials, esthetic contouring, immediate dentin sealing, and novel surgical techniques such as lip repositioning, connective tissue grafting, and ridge preservation with collagen membranes. Dr Terry expanded his team of editorial reviewers to include the best minds in research and clinical practice, and the final product is a testament to his dedication to patient satisfaction and treatment success. The techniques demonstrated in this book will no doubt elevate your practice to the next level.

792 pp; 2,584 illus; ©2018; ISBN 978-0-86715-763-5 (B7635); Now available! $348

Read more about Dr Douglas A. Terry and Esthetic and Restorative Dentistry: Material Selection and Technique, Third Edition here!

Author Spotlight: Douglas A. Terry

 

Bioaesthetics in Oral Rehabilitation: Science, Art, and Creativity

Loris Prosper

This book describes a methodology for creating biomimetic restorations that harmonize with the remaining natural teeth. The authors analyze the methodology for each phase of work, including the diagnosis and treatment planning, the stages of preparation and fabrication, and the cementation of the definitive restoration. All the essential components are covered, including occlusal analysis, soft tissue management, color selection, implant considerations, and guidelines for home maintenance. The merits of a multidisciplinary approach are shown within the functional esthetic paradigm in which the prosthodontist, surgeon, orthodontist, and dental technician work as a close-knit team to ensure a predictable and reproducible result.

896 pp; 3,349 illus; ©2018; ISBN 978-88-7492-039-6 (BI025); US $298

 

New Issues in Journals


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Featured article: A Simplified Approach for Restoration of Worn Dentition Using the Full Mock-up Concept: Clinical Case Reports
Stefen Koubi, Galip Gürel, Patrice Margossian, Richard Massihi, and Herve Tassery

Single-Tooth Replacement Using Dental Implants Supporting All-Ceramic and Metal-Based Reconstructions: Results at 18 Months of Loading
Adrian Bösch, Ronald Ernst Jung, Irena Sailer, Benic Goran, Christoph Hans Franz Hämmerle, and Daniel Stefan Thoma

Retrospective Evaluation of Factors Related to the Outcomes of Regenerative Therapy for Implants Affected by Peri-implantitis
Stuart J. Froum, Paul S. Rosen, Wendy C. W. Wang, Scott H. Froum, and Shalin Vinayak

ijp_banner

Effect of Submerged vs Nonsubmerged Implant Placement Protocols on Implant Failure and Marginal Bone Loss: A Systematic Review and Meta-Analysis
Ramy Moustafa Moustafa Ali, Ahmed Yaseen Alqutaibi, Amr Salah El-din Gomaa, and Mohamed Farouk Abdallah

Prospective Evaluation of Posterior Fixed Zirconia Dental Prostheses: 10-Year Clinical Results
Sven Rinke, Jens Wehle, Xenia Schulz, Ralf Bürgers, and Matthias Rödiger

Wear and Fracture Strength of New Ceramic Resins for Chairside Milling
Karina Zierden, Johannes Acar, Peter Rehmann, and Bernd Wöstmann

jomi_banner

Featured Article: Peri-implant Crestal Bone Changes Around Zirconia Implants in Periodontally Healthy and Compromised Patients
Kristian Kniha, Stefan Milz, Heinz Kniha, Nassim Ayoub, Frank Hölzle, and Ali Modabber

Thematic Abstract Review: Implant-Retained Removable Partial Dentures: A Reliable Alternative Line of Treatment
Emad W. Estafanous

Guided Bone Regeneration with Collagen Membranes and Particulate Graft Materials: A Systematic Review and Meta-Analysis
Bastian Wessing, Stefan Lettner, and Werner Zechner

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Efficacy of Electrical Stimulation of the Occipital Nerve in Intractable Primary Headache Disorders: A Systematic Review with Meta-Analyses
Robert T. Cadalso, Jr; John Daugherty; Caron Holmes; Saravanan Ram; and Reyes Enciso

Effectiveness of Intra-Articular Injections of Sodium Hyaluronate or Corticosteroids for Intracapsular Temporomandibular Disorders: A Systematic Review and Meta-Analysis
Marlon A. Moldez, Victor R. Camones, Guillermo E. Ramos, Mariela Padilla, and Reyes Enciso

Tumor Necrosis Factor Alpha Signaling in Trigeminal Ganglion Contributes to Mechanical Hypersensitivity in Masseter Muscle During Temporomandibular Joint Inflammation
Reio Ito, Masamichi Shinoda, Kuniya Honda, Kentaro Urata, Jun Lee, Mitsuru Maruno, Kumi Soma, Shinji Okada, Nobuhito Gionhaku, and Koichi Iwata

Controlling orthodontic tooth movement with clear aligners: An updated systematic review regarding efficacy and efficiency
Gabrielle Rossini, Simone Parrini, Andrea Deregibus, and Tommaso Castroflorio

Effect of aligner material on orthodontic tooth movement
Timothy Wheeler, Neha Patel, and Susan McGorray

Accelerated Invisalign treatment of patients with a skeletal Class III
Werner Schupp, Julia Haubrich, Kenji Ojima, Chisato Dan, Yuriko Kumagai, and Sumimasa Otsuka

 

Dental Meetings Quintessence Will Attend in March


AO 2018 Annual Meeting: Booth #427
hosted by the Academy of Osseointegration, March 1–3 in Los Angeles, California

ITI Congreso México: Booth #8
hosted by the International Team for Implantology, March 7–9 in Cancún, México

Pacific Dental Conference 2018: Booths #93 & #94
hosted by the PDC Organizing Group, March 8–10 in Vancouver, Canada

AADR/CADR Annual Meeting & Exhibition: Booth #412
hosted by the American Association for Dental Research and the Canadian Association for Dental Research, March 21–24 in Fort Lauderdale, Florida

Upcoming Quintessence Events


 

Posted in Books, Dental Technology, Esthetic Dentistry, Journal of Oral & Facial Pain and Headache, Journals, Misc, Multidisciplinary, Orthodontics, Pediatric Dentistry, Prosthodontics, Restorative Dentistry, Roundup, Special Offer, The International Journal of Oral & Maxillofacial Implants, The International Journal of Periodontics & Restorative Dentistry, The International Journal of Prosthodontics, What's New | Tagged , | Leave a comment

Waxing Poetic: The First Waxing Manual Written Specifically for First-Year Dental Students

Reading time: 7 minutes

When dental students are first taught how to wax teeth, they need clear instructions with logical steps and plenty of illustrations. When Rowida Abdalla, DDS, MS, set out to find such a resource to use in the waxing course she teaches at the University of Kentucky College of Dentistry, she found the literature was coming up short. But teachers and dentists aren’t really the types to just give up if an answer doesn’t exist, and Dr Abdalla is both—so, she created the waxing manual her students needed: Waxing for Dental Students (Quintesesnce, 2018).

Filling the Gap

Students learn how to wax teeth during their first year of dental school,” Dr Abdalla explains. “The purpose of this is to teach them the morphology of the teeth and to develop their hand skills. Waxing is quite challenging in the beginning and requires a lot of practice, and struggling with waxing is a common complaint for first-year dental students. I did an extensive search to find a helpful resource for my students, but none of the waxing manuals available were suitable for first-year dental students. First, there are very few waxing books available period, and what books are available are written for laboratory technicians, not dental students.”

The main difference between waxing manuals for lab technicians and the resource Dr Abdalla created is that the former texts focus mostly on waxing crowns and bridges on dies in occlusion. But waxing into occlusion can be far too advanced for students who are still developing their mechanical skills.

“Although there are similarities between waxing dentoform teeth and waxing dies, there are many differences in the steps when occlusion is not considered,” Dr Abdalla emphasizes. “Waxing a die requires skills and knowledge that first-year dental students are still developing, and texts that include information that they haven’t learned yet, such as trimming dies, crowns, and bridges, can be distracting. The main purpose of the waxing course for first-year dental students is not to create a perfect prosthetic restoration, but rather to teach them the anatomy of each individual tooth so that they will eventually be able to restore teeth to the correct form and duplicate the correct tooth contours. Equally important is the opportunity waxing gives students to familiarize themselves with hand instrumentation techniques. Skills such as finger dexterity, hand steadiness, aiming, and reaction time are essential for the high level of precision necessary in dentistry and are developed during the first-year waxing course. The lessons and steps in the book are presented in a sequence that enables students to develop these skills cumulatively.”

Illustrations from Dr Abdalla’s book showing how to hold waxing instruments when waxing inside and outside the dentoform.

Labial and lingual views of a maxillary central incisor with morphological landmarks labeled.

A Comprehensive Resource for Both Students and Educators

It is clear that Dr Abdalla drew on her teaching experience for every decision made while writing and developing this book. The result is a resource explicitly designed to meet the needs of both educators and students—a resource that’s easy to teach from and easy to learn from.

“I’ve been teaching the waxing course at the University of Kentucky for 3 years,” Dr Abdalla explains, “and in that time I’ve noticed the importance of introductory exercises (partial-crown wax-ups) before moving to full crowns. Partial wax-ups allow the students to focus on the details of the tooth anatomy without needing the high skill involved in building the entire tooth from scratch. I’ve also learned that one or two of these introductory exercises are usually sufficient before moving to full-crown wax-ups, and that additional exercises only take up time without adding much benefit for the student.”

Dr Abdalla has also included evaluation criteria and grading rubrics for the instructor to make her book a more comprehensive course manual.

An example of one of the grading rubrics in chapter 6 of the book.

“The evaluation criteria and grading rubrics are provided so that dental educators who use this book for their courses do not have to create or look for any other resources,” she explains. “The rubrics are designed so that similar criteria are grouped together in the same section, so students are not losing points for the same mistake in more than one section. Some overlap is unavoidable, however, and while it may seem tempting to divide the grading rubric into more sections to eliminate any chance for overlap and focus on each area separately, I’ve found that this usually results in inflating the grades too much.”

Together with the detailed steps and images shown for each procedure in the other chapters, the inclusion of the evaluation criteria in the same book gives students an avenue to check their own work and a clearly stated example of success. The goals for the final wax-up are clearly stated, so students can easily identify areas where they may need to improve their technique. And while the illustrations in the book are certainly beautiful, Dr Abdalla places careful emphasis on practicality above beauty at this stage of learning:

“Properly duplicating anatomy and contours and producing a highly smooth and finished wax-up is the ultimate goal for first-year dental students,” she states in chapter 6. “Producing a beautiful wax-up and a work of art is highly appreciated and desired. However, it should not be forgotten that the whole purpose of waxing is to learn tooth anatomy and acquire hand skills.”

Several steps of a maxillary central incisor full-crown wax-up, as illustrated in the book.

A New Standard

Everything about Dr Abdalla’s book, from the content to the structure, has been created with both the student and the instructor in mind. The result is the first waxing manual written specifically for first-year dental students. Dr Abdalla is optimistic that other educators will be able to find the same success in their courses as she has with this teaching material.

“I’ve found that providing a simple, logical series of steps for waxing helps the students reach the expected goals,” she says. “I really believe this book can be useful for any first-year dental student and can be adopted by dental schools as their main lab manual.”

Her book fills the gap in the educational literature for first-year dental students and will serve to help students learn the skills and techniques they need to move forward in their dental education more quickly and effectively. By confronting one of the barriers to her students’ success, Dr Abdalla has given them a better educational foundation on which to build other, more specialized dental skills. And by incorporating this book into their courses, other dental educators can do the same for their students.


Rowida Abdalla, DDS, MS, is Assistant Professor in the Department of Restorative Dentistry at the University of Kentucky College of Dentistry in Lexington, where she is the director of the dental anatomy, morphology, and occlusion course. Born and raised in Cairo, Dr Abdalla completed dental school, specialty training, and a master’s degree in operative dentistry in Egypt. She taught restorative dentistry for several years in Cairo and worked as a researcher in the National Center for Radiation Research and Technology. Dr Abdalla’s research focused on the prevention of the damaging effects of radiotherapy on tooth structure, specifically for patients treated for head and neck cancer. In 2012, she moved to the United States for training at Eastman Institute for Oral Health in Rochester, New York, where she completed a fellowship in community dentistry and a residency in advanced education for general dentistry. Dr Abdalla was the 2014 recipient of the AMWPA merit award and was honored with an NAAMA grant for academic excellence. She has dedicated her career to teaching restorative dentistry and improving the skills of dental students.

 

Waxing for Dental Students

Rowida Abdalla

When dental students are first taught how to wax teeth, they need clear instructions with logical steps and plenty of illustrations. With the omission of any distracting information about dies, crowns, bridges, and occlusion, this concise book is squarely directed to first-year dental students and can be used as a primary laboratory manual. The author covers the basics of wax instrumentation and addition, but the bulk of the book details the steps for waxing incisors, canines, premolars, and molars. Each chapter includes an introductory waxing exercise for the tooth type, followed by the key points of morphology for the tooth in question. Photographs detail the waxing steps for both a maxillary and a mandibular full crown on a tooth peg and show how the wax-up should mimic the contralateral tooth in terms of dimension, embrasures, heights of contour, line angles, and point angles. The logical and straightforward protocols in this book will help dental students quickly improve their waxing skills and reach expected goals.

88 pp (spiral bound); 388 illus; ©2018; ISBN 978-0-86715-773-4 (B7734); US $58

Posted in Books, Feature, Misc | Tagged , , | 3 Comments

Quintessence Roundup: February

Reading time: 7 minutes

Monthly Special


TMDs: An Evidence-Based Approach to Diagnosis and Treatment

Edited by Daniel M. Laskin, Charles S. Greene, and William L. Hylander

This multidisciplinary textbook presents a unique approach to the diagnosis and management of the various temporomandibular disorders. Written by a large group of eminent researchers and clinicians, it links current scientific concepts of basic anatomy, physiology, biomechanics, and pathology of the temporomandibular joint with specific diagnostic and treatment protocols that are based on sound clinical data. Thus, in keeping with the current thrust in medicine and dentistry, the book provides access to the best available evidence so that clinicians can make informed rather than empirical decisions about what is appropriate therapy. Where lack of data or rapid changes in a particular discipline do not allow for evidence-based conclusions or recommendations, the book highlights the areas of agreement and disagreement in order to expose the deficiencies in our present knowledge base. In a field of treatment long associated with controversy, this book educates readers about which current practices of diagnosis and treatment are strongly supported by scientific research and which are supported only by practical experience and/or anecdotal evidence.

560 pp; 461 illus; ©2006; ISBN 978-0-86715-447-4 (B4470); $158 Special price! $49

 

New Titles in Books


Esthetic and Restorative Dentistry: Material Selection and Technique, Third Edition

Douglas A. Terry and Willi Geller

Restorative dentistry has seen dramatic advances in recent years, especially with the use of digital technologies, and this book provides the most up-to-date information on enhanced developments, materials, and techniques that have emerged since the publication of the second edition, offering the reader a completely updated, revised, and newly illustrated overview of modern esthetic and restorative dentistry complete with tutorial videos. New topics include web-based communication with the laboratory, indirect composite chairside CAD/CAM restorations, a comparison of digital and conventional techniques, the resin composite injection technique, as well as updated information on composites and ceramic systems, including esthetic zirconia. New cases illustrate the maintenance of esthetic restorative materials, esthetic contouring, immediate dentin sealing, and novel surgical techniques such as lip repositioning, connective tissue grafting, and ridge preservation with collagen membranes. Dr Terry expanded his team of editorial reviewers to include the best minds in research and clinical practice, and the final product is a testament to his dedication to patient satisfaction and treatment success. The techniques demonstrated in this book will no doubt elevate your practice to the next level.

792 pp; 2,584 illus; ©2018; ISBN 978-0-86715-763-5 (B7635); Now available! $348

Read more about Dr Douglas A. Terry and Esthetic and Restorative Dentistry: Material Selection and Technique, Third Edition here!

Author Spotlight: Douglas A. Terry

 

Waxing for Dental Students

Rowida Abdalla

When dental students are first taught how to wax teeth, they need clear instructions with logical steps and plenty of illustrations. With the omission of any distracting information about dies, crowns, bridges, and occlusion, this concise book is squarely directed to first-year dental students and can be used as a primary laboratory manual. The author covers the basics of wax instrumentation and addition, but the bulk of the book details the steps for waxing incisors, canines, premolars, and molars. Each chapter includes an introductory waxing exercise for the tooth type, followed by the key points of morphology for the tooth in question. Photographs detail the waxing steps for both a maxillary and a mandibular full crown on a tooth peg and show how the wax-up should mimic the contralateral tooth in terms of dimension, embrasures, heights of contour, line angles, and point angles. The logical and straightforward protocols in this book will help dental students quickly improve their waxing skills and reach expected goals.

88 pp (spiral bound); 388 illus; ©2018; ISBN 978-0-86715-773-4 (B7734); Now available! $58

 

Quintessence of Dental Technology 2018

Edited by Sillas Duarte, Jr

QDT 2018 presents original articles with a beautiful array of images showcasing the year’s newest techniques, materials, tools, and innovations. This year’s focus is decidedly digital—digital treatment planning, digital communication, and digital multidisciplinary workflow for esthetic and functional rehabilitations. Minimally invasive techniques are highlighted throughout, including their use for full-mouth rehabilitation and to restore the morphology of teeth damaged by wear. A special “how-to” article on focus stacking macro photography by Carlos Ayala Paz is the first to be published specific to dentistry.

256 pp; 1,090 illus; ©2018; ISBN 978-0-86715-783-3 (J0629); Now available! $148

 

Digital Implantology

Giuseppe Luongo, Giampiero Ciabattoni, Alessandro Acocela

Digital planning of implant therapy ensures predictable and successful treatment by allowing clinicians to visualize the surgical procedure before they perform it. With this goal in mind, this book lays out the latest research on implant dentistry as well as effective case presentations to demonstrate cutting-edge imaging and surgical techniques. Readers are guided through the process of using digital tools at every stage of treatment, from developing the treatment plan to surgical execution. The authors detail the specifications of guided surgical procedures, review the latest 3D radiology options and software currently available, and present full case studies with stunning photographs. As implant dentistry relies more and more on digital technology, clinicians owe it to their patients to educate themselves on the most current tools available, and this book is the perfect place to start.

392 pp; 1,270 illus; ©2018; ISBN 978-88-7492-032-7 (BI037); US $198

 

 

New Issues in Journals


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Featured article: Late Dental Implant Failures Associated with Retained Root Fragments: Case Reports with Histologic and SEM Analysis
Marc L. Nevins, Laureen Langer, and Peter Schupbach

Immediate Placement of Ultrawide-Diameter Implants in Molar Sockets: Description of a Recommended Technique
André C. Hattingh, Hugo De Bruyn, Andrew Ackermann, and Stefan Vandeweghe

Coronally Advanced Flap with Site-Specific Application of Connective Tissue Graft for the Treatment of Multiple Adjacent Gingival Recessions: A 3-Year Follow-Up Case Series
Martina Stefanini, Giovanni Zucchelli, Matteo Marzadori, and Massimo de Sanctis

ijp_banner

Effect of Submerged vs Nonsubmerged Implant Placement Protocols on Implant Failure and Marginal Bone Loss: A Systematic Review and Meta-Analysis
Ramy Moustafa Moustafa Ali, Ahmed Yaseen Alqutaibi, Amr Salah El-din Gomaa, and Mohamed Farouk Abdallah

Prospective Evaluation of Posterior Fixed Zirconia Dental Prostheses: 10-Year Clinical Results
Sven Rinke, Jens Wehle, Xenia Schulz, Ralf Bürgers, and Matthias Rödiger

Wear and Fracture Strength of New Ceramic Resins for Chairside Milling
Karina Zierden, Johannes Acar, Peter Rehmann, and Bernd Wöstmann

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Featured Article: Peri-implant Crestal Bone Changes Around Zirconia Implants in Periodontally Healthy and Compromised Patients
Kristian Kniha, Stefan Milz, Heinz Kniha, Nassim Ayoub, Frank Hölzle, and Ali Modabber

Thematic Abstract Review: Implant-Retained Removable Partial Dentures: A Reliable Alternative Line of Treatment
Emad W. Estafanous

Guided Bone Regeneration with Collagen Membranes and Particulate Graft Materials: A Systematic Review and Meta-Analysis
Bastian Wessing, Stefan Lettner, and Werner Zechner

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Efficacy of Electrical Stimulation of the Occipital Nerve in Intractable Primary Headache Disorders: A Systematic Review with Meta-Analyses
Robert T. Cadalso, Jr; John Daugherty; Caron Holmes; Saravanan Ram; and Reyes Enciso

Effectiveness of Intra-Articular Injections of Sodium Hyaluronate or Corticosteroids for Intracapsular Temporomandibular Disorders: A Systematic Review and Meta-Analysis
Marlon A. Moldez, Victor R. Camones, Guillermo E. Ramos, Mariela Padilla, and Reyes Enciso

Tumor Necrosis Factor Alpha Signaling in Trigeminal Ganglion Contributes to Mechanical Hypersensitivity in Masseter Muscle During Temporomandibular Joint Inflammation
Reio Ito, Masamichi Shinoda, Kuniya Honda, Kentaro Urata, Jun Lee, Mitsuru Maruno, Kumi Soma, Shinji Okada, Nobuhito Gionhaku, and Koichi Iwata

 

Dental Meetings Quintessence Will Attend in February


2018 Dental XP Global Symposium: Booth #42
hosted by Dental XP, February 8–10 in Hollywood, Florida

360° Implantology
hosted by MIS Implants, February 8–11 in Nassau Paradise Island, Bahamas

Osteology USA National Symposium: Booth #102
hosted by the Osteology Foundation, February 9–10 in Phoenix, Arizona

AAO/AAPD 2018 Joint Winter Conference: Booth #102
hosted by the American Association of Orthodontists and the American Academy  of Pediatric Dentists, February 9–11 in Scottsdale, Arizona

7th IAOCI World Congress: Table #15
hosted by the International Academy of Ceramic Implantology, February 15–17

ADSA Annual Las Vegas Anesthesia & Deep Sedation Meeting
hosted by the American Dental Society of Anesthesiology, February 16–17 in Las Vegas, Nevada

CDS 2018 Midwinter Meeting: Booth #4325
hosted by the Chicago Dental Society, February 22–24 in Chicago, Illinois

AAFP 67th Annual Scientific Session: Booth #123
hosted by the American Academy of Fixed Prosthodontics, February 23–24 in Chicago, Illinois

LMT Lab Day Chicago: Booth #A-12
hosted by LMT Communications, February 23–24 in Chicago, Illinois

Midwest Society of Periodontology Annual Meeting
hosted by the Midwest Society of Periodontology, February 23–25 in Chicago, Illinois

 

Upcoming Quintessence Events


Posted in Books, Dental Technology, Esthetic Dentistry, Implant Dentistry, Journal of Oral & Facial Pain and Headache, Journals, Misc, Promotions, Prosthodontics, Restorative Dentistry, Roundup, Special Offer, The International Journal of Oral & Maxillofacial Implants, The International Journal of Periodontics & Restorative Dentistry, The International Journal of Prosthodontics, What's New | Tagged , | Leave a comment

Author Spotlight: Douglas A. Terry

Reading time: 22 minutes

Few names in modern esthetic dentistry are as recognizable or as influential as that of Douglas A. Terry, DDS. He is a sought-after lecturer around the world, his books are bestsellers that have been translated into multiple languages, and his patients travel to his clinic in Houston, Texas, from all over. Despite his acclaim, Dr Terry maintains a unique approachability and a true desire to meet and interact with everyone his work touches. Everyone who has met Dr Terry has walked away with a memorable story; everyone who has worked with him has seen the imprint his passion and perfectionism leaves behind on their personal work.

With the publication this year of the third edition of his seminal text, Esthetic and Restorative Dentistry: Material Selection and Technique (Quintessence, 2018), we would like to offer our readers a portrait of Douglas A. Terry and the experiences and people who shaped him.

The Beginning

The world is full of people who wanted to be astronauts when they were kids but grew up to be something different. It’s fairly unusual to find someone who grew up to do exactly what they wanted to do when they were young—it’s even more unusual to find someone who wanted to grow up to be a dentist. But that’s exactly what happened with Dr Terry.

“I decided I wanted to be a dentist when I was 9 years old,” Dr Terry recalls. “I liked working with my hands, I enjoyed science, and I was artistic. I also wanted to help people, and based on my visits with our general dentist Dr Thomas Weatherly I thought dentistry was a perfect match for me. Later on as a dental student, I even waxed and cast crowns for Dr Weatherly.”

Dr Terry attended dental school at the University of Texas Health Science Center (UTHSC) Dental Branch at Houston. It was there that he first began to hone his interest in esthetic and restorative dentistry. “During my school years,” he says, “I was able to work with Dr Frank Faunce, who helped develop the Mastique veneer, and from that point on everything was esthetic. The restorative concepts were slowly changing to adhesive dentistry, and Drs Kenneth Porter, James T. Miller, and John Chandler were great mentors. They taught me the significance of detail in any restorative procedure.”

Dr Terry recalls his first restoration: “I always ask my colleagues if they remember the first restoration they did in dental school. Mine was a Class I restoration on a mandibular left second premolar. I had stayed up all night reviewing G. V. Black’s principles. I had the dental dam on and had prepared the cavity, and then my teacher came over, flipped his loupes down, and said, ‘Douglas, come out into the hall.’ He said, ‘You are not into the dentin—go deeper.’ So I did and I called him back. He took a look at my preparation and said, ‘Douglas, come out into the hall. You must extend the cavity preparation into the grooves.’ So I did. He came back and finally said, ‘Now you can apply copalite and place your amalgam.’ And that was my first restoration. But several years ago, that teacher ended up in the second row at one of my presentations. And I told him, ‘Today, we could have stopped in the dentin and had a more conservative, reinforced, beautiful restoration.’ And he said, ‘Now you are my teacher!'”

After graduation in 1978, Dr Terry continued to pursue new knowledge and build connections with others who had the same goal—to lift esthetic and restorative dentistry to new heights. The inspiration for the first edition of Esthetic and Restorative Dentistry: Material Selection and Technique came from a desire among Dr Terry and his colleagues, both dentists and technicians, for a definitive resource that showed not just what to use and when, but also how. At the suggestion of Willi Geller, MDT, in 2002 Dr Terry organized a group of interdisciplinary colleagues from around the world and called the group design Technique International (dTI). The motivation behind this group, which included master technicians, clinicians, and biomaterial scientists, was that an international editorial team from different educational and clinical backgrounds would provide the best source for solutions to the questions Dr Terry wanted to answer in his book. Over the next 5 years, the book slowly took shape.

“The first edition of Esthetic and Restorative Dentistry was published in 2009,” William Hartman, Executive Vice President and Director of Quintessence Publishing USA, recalls. “When Christian Haase, our Managing Director, met Douglas at a dental conference, he was already well known internationally and had published the first edition of the book. He had self-published and was learning, like many authors do, that marketing and selling books—especially a single title—is quite costly. We were impressed with the quality of the publication and decided that we would take the book on and distribute it if he promised to do the second edition with Quintessence. After the first edition sold out, he completed the second edition with us, and Douglas officially became a Quintessence author.”

The second edition of Esthetic and Restorative Dentistry, published by Quintessence in 2013, also sold out. Dr Terry has written a total of six books with Quintessence, which have been translated into multiple languages and distributed internationally. “Like many Quintessence authors,” Mr Hartman says, “Douglas is part of a distinguished group around the world who influence the industries of restorative dentistry and prosthodontics. His books play an important role in that. Today, not many dental texts can boast that they’re in their second edition, let alone their third, and that both previous editions have sold out.”

“Working with Dr Terry is certainly unique,” his editor, Leah Huffman of Quintessence, says. “He likes to be as involved as possible and is always willing to hop on a plane to make sure we can go over everything in person. He never wants to miss anything or leave anyone out, so he will painstakingly go over the entire book multiple times. Dr Terry is also the best ambassador for his books that I’ve ever worked with. His passion for his craft and for educating future generations is obvious to anyone who has a conversation with him, and he connects with people on a personal level at every opportunity.”

These personal connections aren’t just a facade to sell books and do business, though. For Dr Terry, personal connections are what motivate him to succeed, whether it’s connecting with students during a lecture or connecting with patients in his clinic. In everything he does, Dr Terry’s work is driven by a genuine desire to serve and a devotion to his patients.

A Patient-Centered Philosophy

Dr Susana Paoloski, a periodontist who often collaborates with Dr Terry on cases and who has been on the editorial board of Esthetic and Restorative Dentistry since its first edition, describes Dr Terry’s unique approach to interdisciplinary care:

“Working with Douglas on a case is an inspiring intellectual pursuit,” she says. “The patient’s needs and expectations are the starting point. He insists on bringing the patient to meet the team in person if feasible, and if not he presents photographs revealing the personal characteristics and traits of the patient—who they are, what motivates them. The individual patient is always at the center. Douglas understands the concept of a team: where the collective decisions and opinions are much more than the individual contributions. It is an intense process with all the movable parts blending to form a diagnosis and treatment plan. We start with the desirable outcome for the patient, and together we develop the steps to reach it.”

Drs Terry and Paoloski frequently collaborate on cases.

But even outside the clinic, patient care remains the central motivation for Dr Terry.

“Douglas is committed to dentistry as a science-based profession that improves peoples’ lives,” Dr Paoloski continues. “He is moved by curiosity and the constant pursuit of excellence. His challenge is to develop materials and techniques to enhance results, benefitting both patients and practitioners. In his mind, there is always a better way to do it or teach it, and he never gives up before he finds his answer.”

“He cannot tolerate poor dentistry for patients,” John O. Burgess, DDS, MS, states. “He desires that everyone receive the finest care possible. Over the years that I have known him, I have realized that he is one of the most dedicated and passionate dentists I have ever met. I mean, all the leaders are passionate and partially mad about dentistry—but Dr Terry is extreme. Once you realize this, you start to really understand him and his drive to learn more and do better and better. He is confident and not afraid to try new concepts, materials, and techniques to see how they perform, and as such he is constantly leading the field. For example, his very successful flowable composite resin restorations and his advancement of all-ceramic restorations place him at the top of leading esthetic dentists.”

“Douglas has profoundly impacted the teaching and practice of dentistry,” Dr Paoloski says. “He asks fellow dentists to take a leap: to question the orthodoxy, to expand their thinking, to defy the status quo. He is an advocate for excellence—both individually and collectively. He inspires other dentists to feel excited to be a health professional at this time in our history. Douglas is an artist who happens to be a dentist.”

An extension of Dr Terry’s patient-centered treatment is that the patient must be part of the restorative team. Dr Terry explains: “One of my patients of many years, Stephan, taught me the importance of making the patient the team captain for improved oral health. To ensure a lifelong smile, the patient must adopt the oral health philosophy of the dental team. It’s important to visually explain and inform patients, whether children or adults. Most clinicians use visual learning to guide their patients, which is why these books are so widely used. The book Smile! Your Guide to Esthetic Dental Treatment is an evolution of our philosophy in that it helps enable informed consent from the patient for many restorative and esthetic procedures. With proper informed consent, the patient can make educated choices for their dental care.”

This idea that the patient must be part of the restorative solution creeps into all of Dr Terry’s work and most of his conversations on restorative dentistry. It is also evident in the texts he has written specifically for patients. His book What’s in Your Mouth? Your Guide to a Lifelong Smile guides adult patients on proper brushing and flossing techniques and educates them on potential consequences of subpar oral care. What’s in Your Mouth? What’s in Your Child’s Mouth? accomplishes the same goal, but for pediatric patients and their parents. Both books center on the patient as the main catalyst for improved oral health.

By becoming part of the restorative team, Dr Terry’s patients are able to accept their share of the responsibility for the success of each restorative procedure. Madison Willis, a 12-year-old patient from Houston, Texas, describes how Dr Terry convinced her to do her share of the work. “He told me that brushing my teeth is like making the right moves to win a game of checkers—you have to make the right moves to keep your teeth healthy, so he showed me how to brush my teeth in circle motions to get all the bugs (plaque) off my teeth.”

“Dr Terry explains and educates patients about the reason that led to the issue, the process and steps that need to be taken to resolve it, and the patient’s role in the process,” Andrey Verloka, a patient from Houston, Texas, emphasizes. “The treatments he offers are aimed to reach the highest level and to improve not only the esthetic look but also the long-term oral health. He is very detailed—he doesn’t rush while preparing the tooth. He tries to preserve teeth by applying conservative approaches and then watches the progress to determine if further and more aggressive forms of treatment are needed.”

Mr Verloka and Dr Terry share a special bond after the past year. While they had already developed a friendship thanks in part to Dr Terry’s patient-centered approach to treatment, on August 25, 2017, Mr Verloka went above and beyond to help his dentist during a time of need.

Dr Terry explains: “I was in Denver, Colorado, when Hurricane Harvey hit and Houston started flooding. At 11:45 pm I received a call from my mother—the water was rising in her house and covering her feet. I immediately called the chief of the fire department in her area, and he rescued her from the rising water in her home. The next morning I called Andrey. He picked up my mother, my assistant Melissa Nix, and my two babies (Boston terriers, Sir James and Bellamina) and drove them to his home 75 miles away. He placed his own life in danger to protect what was dear to me while I was grounded in Denver. Later, after I was finally able to get a flight to Austin, Texas, he drove 300 miles to pick me up from the airport. Our relationship began first as dentist and patient while he was still in Russia; now, I consider his friendship truly a God-sent blessing.”

From left to right: Andrey Verloka; Chuck Tylka, Fire Chief of the Southeast Volunteer Fire Department of Houston, Texas; Sue Terry; and Douglas A. Terry.

The Moral Compass and Pursuit of the Truth

If you’ve ever met Dr Terry, you probably walked away with his calling card—The Moral Compass, a customized coin on which he has had several guiding principles inscribed. The directions include humility, empathy, respect, and self-discipline. Most importantly, the compass’s north is represented by Truth. The back of the compass reads, “The search for knowledge and wisdom can lead to the discovery of truth.” Just as Dr Terry directs others to use the compass for guidance in their lives, he also relies on these principles in his own life.

“It all began 14 years ago,” Dr Terry says, “when I tried to help several patients who had been mistreated.”

What he had stumbled upon was a web of Medicaid fraud, where dentists were overtreating child patients for big payouts. Further, in his pursuit of justice for these patients he discovered one large obstacle: members of the Texas State Dental Board of Examiners regularly appeared as expert witnesses for the defense at the malpractice trials of clinicians accused of violating the policies the Board was charged with enforcing. To achieve justice for his patients, Dr Terry would have to go against the governing board for his profession and possibly put his career on the line. He joined the group Texans for Dental Reform and successfully lobbied to have the Board rules changed.

“It is far easier to stay on the sideline and not get involved,” Drew Clawson, one of Dr Terry’s patients, says, “but Dr Terry is a strong proponent of changing the way the profession handles unethical work practices that are detrimental to patients. Instead of backing down, he became an activist in dental professional ethics monitoring and reporting and how those poor practices are handled by those with jurisdiction.”

“In our state, dentistry has become a vehicle to become rich at the expense of patients who are harmed,” patient Lucille Zalud says, “but Dr Terry has put his time and money into helping the people of Texas receive dental care according to the standard of practice that governs all dentists. His relentless pursuit of the State Board of Dentists has cost him more than anyone knows. Dr Terry is the best example I know of a man fighting for a cause no matter the cost.”

But the fight didn’t come without backlash. “My life was turned upside down,” Dr Terry recalls, “but God gave me the courage and knowledge to endure the bad behavior of many professionals. I learned many things during that time, but one thing stands out: there are pigs and there are principles. I had never before experienced the pigs in our profession and how they want to cover up the truth. From this tumultuous time, new laws were made and Medicaid fraud and the overtreatment of children was exposed. The principles prevailed, but the pigs still remain.

“The coin that you see in all of my books is a symbol of this traumatic time in my life. On my compass, truth is north. Truth can be different for each of us based on our experiences, culture, and religion, but each of the values on the coin are values we should have for each other.”

Many of Dr Terry’s innovations have been to make esthetic and restorative dentistry accessible to more patients. For example, his recent book Restoring with Flowables champions flowable composite resins as a material that can be used to provide economically feasible and technically viable solutions to a variety of esthetic and restorative problems. When asked why it is important to innovate on both ends of the financial spectrum, he says, “Esthetic dentistry should be accessible to everyone,” then provides the following quote:

A smile costs nothing, but gives much. It enriches those who receive, without making poorer those who give. It takes but a moment, but the memory of it sometimes lasts forever. None is so rich or mighty that he can get along without it, and none is so poor but that he can be made rich by it. A smile creates happiness in the home, fosters good will in business, and is the countersign of friendship. It brings rest to the weary, cheer to the discouraged, and sunshine to the sad, and is nature’s best antidote for trouble. Yet it cannot be bought, begged, borrowed, or stolen, for it is something that is of no value to anyone until it is given away. Some people are too tired to give you a smile. Give them one of yours, as none needs a smile so much as he who has no more to give.

Based on the writings of Rabbi Samson Raphael Hirsch

The People Who Make You

In the second edition of Esthetic and Restorative Dentistry, the opening spread of chapter 10 features a special oil painting done by one of Dr Terry’s mentors at UTHSC, James T. Miller, DDS.

“Dr Miller was my teacher, my friend, and a second father to me,” Dr Terry says. “He was an artist and a dentist who painted. One time I asked him to paint me a picture of a clown, and in response he painted me as a clown in the dental mirror back when I was his student and asking him an endless stream of questions about everything. Later in his life, I commissioned him to go around Texas and paint churches. He made five paintings for me, which I have hanging in my office. One of them is of a little church in the middle of downtown Houston. It was sandwiched between all of these modern skyscrapers, and he had painted the reflection of the church in complete detail, just as it appeared on the huge glass skyscraper next to it. That painting taught me that we should look closer at the important things our friends and family are trying to share with us and not wait until they are gone. At the end of his life, he called and asked me to come to his home, where he told me he had liver cancer and only months to live. In the corner of his office, he had a painting wrapped up, and he said it was for me. It was this beautiful painting of a clown that I had always admired. And now I’m able to share the stories of what he taught me whenever I share that chapter with my colleagues or when patients ask about the paintings in my office, and I can share with them this beautiful smiling clown.”

In the cycle of mentorship, it’s a natural ending: the torch must be passed. When Dr Terry speaks about the people who have mentored him, the admiration he feels for their work and their effects on his life are evident. Just like how he keeps Dr Miller’s paintings displayed prominently in his office, Dr Terry always refers back to the people who came before and have influenced him. But none have had as profound an effect on his career as Willi Geller, MDT. In 2000, Dr Terry described the significant impact meeting Mr Geller had on his career in an issue of the Journal of Cosmetic Dentistry:

I attended a meeting years ago in the south of Spain at the request of a dear friend. I did not know the profound effect this encounter would have on my very existence.

Prior to this gathering, I used the words of ‘maestro’ and ‘mentor’ interchangeably, not understanding the true meanings. The thesaurus cites other terms akin to maestro: artist, master, professional, sage, authority, expert, genius, and virtuoso. When searching for the individual willing to impart their knowledge, share their skills, and teach the true meaning of enlightenment, such a denotation is for what one searches. A maestro consists of a true teacher, not giving you the answers but instructing you on how to think for yourself. He teaches one to observe their surroundings and to become humble to the universe and its greatness. Humanity becomes more significant and the person, the ego, slips from importance. The maestro teaches us how to reach our creative potential in life.

My maestro, my teacher of several years, gave me an appreciation for mankind and the philosophies of life not taught in dental school. He showed me that by studying nature and developing our senses, we become a ‘true artist,’ not by wrapping ourselves up in our profession and its perceived importance….

….Because the word ‘maestro’ caused me to search for the true meaning of the words I use, I found that the word ‘friend’ has also taken on a deeper meaning. One man has changed the way I practice dentistry and changed the way I look at the world. More importantly than all this, one man—my maestro—has changed the way I view friendship. Thank you, my friend.

Mentorship builds a bridge between one generation and the next, thus ensuring the passage of knowledge. In his speech “A Backward Look to the Future,” the physicist E. T. Jaynes said that a teacher’s goal should be “not to implant in the student’s mind every fact that the teacher knows now; but rather to implant a way of thinking that will enable the student, in the future, to learn in one year what the teacher learned in two years. Only in that way can we continue to advance from one generation to the next.” Necessary also to this continued advancement is that some students will one day become teachers.

“What makes our authors great,” Mr Hartman says, “is their commitment to excellence and the strong desire to teach others. They do not want to just show what great things they can do—they really want to help empower the younger dentist and student to be able to achieve the same results. Dr Terry is one of the best examples of this.”

“It is interesting that many dentists can do the same things as Dr Terry, but few can teach others to do that level of work,” Dr Burgess observes. “He is an effective teacher, motivator, and author. His work keeps me thinking about dentistry and how valuable our services are. He drives me to excel—some people can do that to others, they can push you and aid you to get to the top. Dr Terry is one of those.”

Perhaps second only to his devotion to serving patients is Dr Terry’s devotion to education. This is the motivation behind the many books, articles, lectures, and workshops: to teach and inspire the next generation. Rocío Barocio, DDS, MS, is one of the young dentists who have been inspired by Dr Terry’s work.

Dr Douglas A. Terry and Dr Rocío Barocio.

“My life took a sudden shift in the right direction when I met Dr Douglas Terry,” she recalls. “I will never forget it: July 27, 2012, in Guanajuato, México. I was in dental school, and I loved going to the library in my free time to browse the first edition of Dr Terry’s book Esthetic and Restorative Dentistry. I was amazed by how beautiful and perfect all of his case photos were and I enjoyed learning new dental words in English. One day my father (also a dentist) showed me a flyer announcing a dental meeting to be held in Guanajuato. I saw Dr Terry’s photo on the flyer and told my father I really wanted to meet him. He said we could make a road trip out of my mother’s upcoming birthday, July 28, which I later found out is also the birthday of Dr Terry’s mother. We made the 8-hour drive from my hometown Torreón just so I could meet this renowned author. I asked my dental school for permission to check out Dr Terry’s book for the weekend so I could have it signed by him, and off we went!

“The lectures started on Friday, July 27, and Dr Terry was lecturing the next morning. I decided to take the book with me to the Friday lecture just in case he was around. Once the lecture finished, I turned around and could not believe my eyes—there he was, standing in the back of the room! I was so nervous but also so excited at the same time. I introduced my father and myself and asked if Dr Terry could please sign the book I had brought from my dental school. My first impression of Dr Terry was that he was very kind, nondiscriminatory, and positive. He told me, ‘Come to my lecture tomorrow, and I will give you a very special coin.’

“The next morning I was the first person in the lecture room. There was a raffle for a copy of his book and—unbelievably—my dad got it! At the end of the lecture, Dr Terry gave me his coin: The Moral Compass. It was such a special moment for me, and to this day I keep the coin in my nightstand. He has told me it brings good luck, and it certainly has done so for me. After that lecture I asked Dr Terry what his advice would be for me as I was applying to prosthodontics programs in the United States. He told me he would happily write me a recommendation letter and to send him my CV. A few weeks later, he called to ask me some questions about my CV, then told me to wait for an interview invitation. And it happened. In October, I had my first interview to go into residency and was accepted at the University of Alabama in Birmingham. Dr Terry had changed my life.

“Dr Terry has had a significant impact on the field of dentistry,” Dr Barocio continues, “and one that is truly unique. His most important contributions are seen in his books: the eloquent writing, impeccable documentation of cases, and commitment to clinical advancement is second to none. Anyone who reads his books or hears him lecture instantly knows what a special person he is. The advances in clinical techniques he has pioneered will continue to help patients for generations to come. His techniques and attention to detail have influenced my work as well: through his work, I came to realize the level of quality a true perfectionist can achieve. I strive to become as good a dentist as Dr Terry, and I am honored to have him as a mentor. He has given me something to strive for as I continue my education, and this goal will continue to drive me throughout my clinical career. His success as an author, educator, and clinician is because he is real. What makes him such a unique personality in dentistry is the overflow of positive energy he carries with him everywhere he goes. I always knew that I wanted to work with him because I wanted to be associated with the best. A person like Dr Terry makes you achieve things you didn’t even realize were possible. Then, once I got the opportunity to know him better, I understood what a great person and friend he is as well. There is no doubt in my mind that he will have an enduring impact. Future dentists will be better dentists and people because of the example he has set. We owe him a debt of gratitude for the legacy he will leave for the profession.”

Le feu sacré

There is a distinct parallel between the words Dr Terry wrote about his maestro Willi Geller in 2000 and the words Dr Barocio writes about Dr Terry in 2018. In their words, you can hear the torch being passed; in their work, you can see the reflection of the people who have influenced their paths. A person’s legacy resembles the roots of a tree, with each branch representing another person their life has touched.

“I once gave small rocks out during one of my presentations,” Dr Terry says. “I told the audience that if they threw that rock into the water, it would cause a ripple around the world. That is exactly what my teachers have done, and it continues with myself and everyone we touch.”

Dr Terry’s own definition of success is to give more than you take, and each time he pours his heart into another book, it is inarguably a success.

“In all of his activities,” Jean-François Roulet, DDS, PhD, concludes, “Douglas conveys the message that perfection and meticulousness are the promoters of success. Working with him is a pleasure, though sometimes tiresome, because he challenges you as much as he challenges himself. Paired with the right direction on his compass, he is showing again and again that successful dentistry—which lasts long—is multifaceted and possible. I admire his quest for excellence and how he stands up to tell people if they deviate from this credo. He says what he thinks and he does what he says. This, combined with his great talent, makes him who he is. It is le feu sacré—the holy fire that burns inside him and gives him the enthusiasm and energy to never let his patients and students down.”


Esthetic and Restorative Dentistry: Material Selection and Technique, Third Edition

Douglas A. Terry and Willi Geller

Restorative dentistry has seen dramatic advances in recent years, especially with the use of digital technologies, and this book provides the most up-to-date information on enhanced developments, materials, and techniques that have emerged since the publication of the second edition, offering the reader a completely updated, revised, and newly illustrated overview of modern esthetic and restorative dentistry complete with tutorial videos. New topics include web-based communication with the laboratory, indirect composite chairside CAD/CAM restorations, a comparison of digital and conventional techniques, the resin composite injection technique, as well as updated information on composites and ceramic systems, including esthetic zirconia. New cases illustrate the maintenance of esthetic restorative materials, esthetic contouring, immediate dentin sealing, and novel surgical techniques such as lip repositioning, connective tissue grafting, and ridge preservation with collagen membranes. Dr Terry expanded his team of editorial reviewers to include the best minds in research and clinical practice, and the final product is a testament to his dedication to patient satisfaction and treatment success. The techniques demonstrated in this book will no doubt elevate your practice to the next level.

792 pp; 2,584 illus; ©2018; ISBN 978-0-86715-763-5 (B7635); US $348 Special preorder price! $278
Available February 2018

 

Douglas A. Terry, DDS, received his dental degree in 1978 from the University of Texas Health Science Center (UTHSC) Dental Branch at Houston. He is an accredited member of the American Academy of Cosmetic Dentistry, an active member of the European Academy of Esthetic Dentistry, and an honorary member of the Indian Academy of Restorative Dentistry. He has served as a research associate for REALITY Research Lab and as a clinical associate for REALITY Publishing, and he is a member of the International Association for Dental Research. Dr Terry has received a number of professional awards as well as fellowships in the American and International College of Dentists, the Academy of General Dentistry, and the International Academy of Dental Facial Aesthetics. He is a member and the US vice president of Oral Design International. Dr Terry is also an editorial member of numerous peer-reviewed scientific journals and has published over 230 articles on various topics in restorative dentistry. He has authored the textbook Natural Aesthetics with Composite Resin (Montage Media, 2004) and Restoring with Flowables (Quintessence 2017), in addition to several other titles. He has lectured both nationally and internationally on various subjects in restorative and esthetic dentistry. Dr Terry is the founder and CEO of design Technique International and the Institute of Esthetic and Restorative Dentistry. He maintains a private practice in Houston, Texas.

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