Stan Goff is a Managing Editor with MJH Life Sciences, which includes Dental Products Report, Dental Practice Management, Dental Lab Products, Modern Hygienist, and Dentist's Money Digest. He has covered the dental industry since 1999 and can be reached at sgoff@mjhlifesciences.com.  

OSAP Unveils New Name and Logo as it Rebrands to Assn. for Dental Safety | Image Credit: © Association for Dental Safety

Dental professionals have long associated “OSAP” with safety. Now, with a new name and a new logo, the organization is rebranding to further emphasize its goal of safety.

The Organization for Safety, Asepsis and Prevention (OSAP), the leading organization dedicated to ensuring every dental visit is a safe visit, just unveiled its new name: Association for Dental Safety (ADS). After careful consideration, the organization has decided to refresh its brand identity to reflect better its values, vision, and commitment to its members and stakeholders.

The new name, Association for Dental Safety, encapsulates the essence of the group’s mission and aspirations for the future.

"Our decision to rebrand to ADS represents an exciting milestone in our 40-year journey as an organization," Michelle Lee, CPC, ADS Executive Director, says in a press release. "As we continue to evolve and grow, it's essential for our brand to resonate with the diverse dental community. We believe that ADS captures the spirit of who we are and signals our dedication to patient and provider safety, science-based learning, integrity, competent community, and collaborative leadership."

The rebranding process involved extensive collaboration with stakeholders and branding experts to ensure that the new name accurately reflects the association's core values and strategic direction, ADS explains. The association is confident that this change will strengthen its position as an infection prevention and safety leader within the dental community.

ADS is introducing an updated logo and visual identity along with the new name to complete the rebranding process. The new logo includes a shield symbolizing strength, protection, and reliability; the floating stars convey insightfulness and forward-thinking.

ADS is keeping the OSAP green and introducing dentistry's trademark purple, which conveys compassion, purpose, and inspiration, according to the press release. Members can expect a seamless transition, with all existing benefits and services remaining unchanged, the association states.

"We are excited to embark on this new chapter as ADS," adds Lee. "Our commitment to empowering our members, driving innovation, and advancing infection prevention and safety remains unwavering. We look forward to continuing our journey to keep people safe with renewed energy and enthusiasm under our new identity."

ADS invites members, partners, and the broader dental community to join in celebrating this significant milestone. More updates and announcements are planned as the association transitions to the new brand identity over the next few weeks.

Founded in 1984, the Association for Dental Safety (ADS), formerly known as OSAP (osap.org), is the only dental membership association for oral health care professionals that focuses exclusively on dental infection prevention and patient and provider safety. ADS helps operationalize dental infection control and safety laws, regulations, guidelines, standards, and best practices to ensure every dental visit is a safe visit.

Articles

The Organization for Safety, Asepsis and Prevention is refreshing its brand identity, but still focusing on dental infection prevention and patient and provider safety.

OSAP Unveils New Name and Logo as it Rebrands to Assn. for Dental Safety

Kellie Nock is the assistant editor for Dental Products Report. She graduated from Kent State University in 2018 with a Bachelor's in Journalism. Kellie enjoys multimedia content creation with a focus on audio and video storytelling. 

Professional Transition Strategies Announces Headwaters Practice Transitions. Image credit: © Professional Transition Strategies


Dental practice merger and acquisition group Professional Transition Strategies has announced a new expansion with Headwaters Practice Transitions. This new service will focus on smaller dental practices and their owners that are hoping to sell to another doctor, according to a press release from the group.

Practice transitions experts Todd Sheets, Kim McCleskey, and Dominick Ricciardi will lend their expertise on the leadership team at Headwaters Practice Transitions. Founder and president of Professional Transition Strategies, Kyle Francis, expressed enthusiasm in the press release.

“As the industry continues to evolve, we recognize the importance of providing tailored solutions to meet the range of clients’ needs,” Francis said in the press release. “With the launch of Headwaters Practice Transitions, we are ecstatic to extend our expertise and personalized approach to these practices, empowering dental entrepreneurs with the resources they need to navigate transitions seamlessly.”

Headwaters will provide guidance in all matters sales, merging, and acquisitions, with industry insights on proper valuation of the practice, negotiation strategies, and more. To learn more about this expansion, visit the company’s 

Professional Transition Strategies will now offer Headwaters Practice Transitions, designed to help smaller dental practice owners sell their dental practice to other clinicians. 

Professional Transition Strategies Announces Headwaters Practice Transitions

Hartzell Cone Socket Scalers and Curettes from Nordent

All the latest dental product launches from May 27 – May 31, 2024. 

New Dental Products – May 27 - May 31, 2024

Katrina M Sanders RDH, BSDH, M.Ed, RF, is a graduate and recipient of countless awards from the University of Minnesota’s School of Dentistry Division of Dental Hygiene. She is proud to currently serve on the alumni society for one of the most prestigious dental schools in the country. Katrina’s professional career emerged as an educator when she attained full-time employment with a career college in Phoenix, Arizona. A physical manifestation of Katrina’s commitment to her profession is in the development of her textbook, "Introduction to the Dental Hygiene Profession." Katrina proudly received her Master’s Degree in Educational Leadership with distinction through Northern Arizona University as a Phi Kappa Phi Honor Society distinguished member. Currently, Katrina is a distinguished speaker with Dental Hygiene Culture as she lectures nationally in a variety of dental hygiene continuing education content.

Join the Sanders sisters and Dog Dad/VetMed Expert Adam Christman, DVM, MBA, as they discuss all things dental health for our beloved furry (and scaly/feathery/fuzzy) friends.




Adam Christman, DVM, MBA, is the chief veterinary officer for dvm360®—an MJH Life Sciences Company™—who oversees content strategy and development and is the brand voice and personality for dvm360®’s multimedia channels. As a charismatic leader, he brings wit, humor, and authenticity to animal health care as the host of dvm360 Live!™ talkshow, The Vet Blast Podcast and many media channels.

Christman has also been in small animal private practice and shelter medicine for 18 years prior to transitioning his role into continuing education and media. He currently serves on the New Jersey Veterinary Medical Association. He received his DVM degree from Iowa State University’s College of Veterinary Medicine and his MBA from Aspen University.

Christman is an international thought leader, speaker and author on practice management, social media, and rehabilitation, and co-authored, 

Honey, Have You Squeezed the Dachshund? A Pet Owner’s Guide for Owners Who Are Terrified of IVDD

—a book on dogs with disabilities. He was recently awarded the 2023 VMX Speaker of the Year on Practice Management, the 2023 Bright Minds Veterinary Influencer of the Year and the 2023 Iowa State University’s Switzer Alumni Award.

He has been featured in multiple publications as well as on TV, radio and internet shows throughout the country sharing his expertise and passion on all things veterinary medicine.

As an avid social media influencer for animal health care, with over 2 million followers on social media, Dr Christman believes in power of laughing and learning together. He loves to engage with fellow pet parents and veterinary professionals across social media. Christman is an advocate of Pride VMC. He is also the proud dog dad to 4 dachshunds and believes no one should be deprived of the beautiful human-animal bond.

Podcasts

Join the Sanders sisters and Dog Dad/VetMed Expert Adam Christman, DVM, MBA, as they discuss all things dental health for our beloved furry (and scaly/feathery/fuzzy) friends.

Floss & Flip Flops – Episode 30 – Vet Health & National Puppy Party Day with Dr Adam Christman

Dr Kurtzman has completed over 4,500 hours of continuing education in the areas of implant dentistry, cosmetic dentistry and other dental topics. A graduate of The AAID / Howard University College of Dentistry Implant Maxi Course, he has been trained in all aspects of Implant Dentistry. He has achieved fellowship in the Academy of General Dentistry (AGD), Pierre Fauchard Academy (PFA), International Congress of oral Implantologists (ICOI), the American College of Dentists (ACD) and the Academy of Dentistry International (ADI). Holds mastership in the AGD and the Implant Prosthetic Section of the ICOI. He also has achieved diplomate status in the ICOI and the American Dental Implant Association (ADIA). He is a former Assistant Program Director for an university based Implant Maxi-Course and a former Assistant Clinical Professor at University of Maryland, Baltimore School of Dental Surgery in the department of Endodontics, Prosthetics and Operative Dentistry. An International lecturer, he has been recognized annually since 2006 as on of the "Top Dental Lecturers" by 

. Dr Kurtzman has published over 180 dental articles in national and international dental journals and is a consultant to multiple dental manufacturers.

Matteo Antonini, DDS, earned his doctorate in dental surgery from the University of Milan, Italy, in 1993, achieving specialization in orthodontics in 1996 and oral surgery in 2008. He is the inventor of the SilverPlug and a speaker at numerous congresses and courses globally. He maintains a private practice in Varese, Italy, and can be reached at m.antonini@silveraid.it.

Focus on peri-implantitis has increased in recent years, due to an escalation in reported incidence. This has not been due to growing case numbers, but to more frequent identification of this pathological process as practitioners come to understand the signs and symptoms.

Peri-implantitis is a pathological process that occurs at the bone surrounding dental implants and is characterized by inflammation of the soft and hard tissues adjacent to the implant, which leads to progressive loss of bone supporting the implant. It may appear as mucositis early in the life of an implant or many years after restoration of the implant, and may progress slowly or in an accelerated manner depending on the causative factor and the patient’s immune system.

Peri-implant disease is classified as either peri-implant mucositis or peri-implantitis. Peri-implant mucositis is classified as inflammation found only around the soft tissues adjacent to the implant, with no bone loss evident. Peri-implant mucositis is a precursor to peri-implantitis and may be successfully treated to prevent progression to peri-implantitis when identified early enough. With peri-implantitis, the gingival inflammation has progressed to the underlying bone, leading to deterioration of osseous support of the implant. Treatment of peri-implantitis typically requires surgical intervention to stop progression and repair the lost hard tissues.

The clinical conditions leading to the conversion from gingival inflammation to peri-implantitis are not completely understood.

 Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft-tissue inflammation is rare.2 Peri-implant mucositis is a relatively benign, reversible condition, yet can progress to peri-implantitis.

 Some patients, particularly smokers or those with a history of chronic periodontitis or diabetes, are more susceptible to peri-implant diseases.

So, where can bacteria originate before leading to peri-implant mucositis and potentially peri-implantitis? The oral cavity is filled with bacteria and other microorganisms. Historically the focus has been on poor home care as a major factor in peri-implant disease, but other sources of microorganisms in the oral cavity need to be considered. Research has demonstrated that bacteria in the oral biofilm can be harbored between the implant and the restorative parts connected to it at the implant platform.

The Implant Connection as a Potential Source of Bacteria

When implant abutments and other parts that connect to the implant at its platform are manufactured, large volumes of product are machined, and what is referred to as “slop” is designed into the process to allow for tolerance variables and product parts that fit. This is so that any abutment will seat into any implant when manufactured. The result is a microgap between the implant and abutment at the connector. This also pertains to the abutment screw that will thread into the channel in the implant (

). That microgap is not visible to the eye, but only under the scanning electronic microscope; however, it is large enough for bacteria that are much smaller to exist in the microgap. These bacteria then have the potential to percolate out, leading to inflammatory conditions in the surrounding gingival tissue and potentially spreading to the crestal bone.

A study reported microgap sizes ranging from 2 to 7 µm at the implant-abutment connector, whereas another reported a variation in microgap size ranging from 10 µm to 1.72 mm, which is wider than the bacteria found in the oral environment.

 Biofilm has an adhesive nature, sticking to all surfaces in the mouth including titanium and zirconia, from which implants are fabricated.

Additionally, micromovements during occlusal function can lead to wear at the implant connector,increasing the microgap sizes.

This can lead to a pumping effect, pushing bacteria in the connector in and out of the connection and being a further source that may lead to gingival inflammation.

Whether the restoration will be retained with a screw or be an abutment with overlaying cemented restoration, a screw is utilized to fixate something to the implant at the platform. A pliable material is required to not occlude the hex or square on the fixation screw so that it can be engaged to either remove the screw or tighten it when required. Traditionally, this was accomplished with a piece of a cotton pellet that in the case of a screw-retained restoration was then sealed at the crown’s surface with a composite resin.

A shift occurred some years ago to utilizing a piece of polytetrafluoroethylene (PTFE [plumbers’ tape]) to overcome the bacteria and odor noted when the composite was removed from over the plugging material or in the case of a cemented restoration when the abutment was exposed to access the screw. Studies have reported high levels of streptococci and fungi were found in those cotton pellets, with less noted when PTFE plugs were used.

 But, being an inert material, PTFE does have the potential to allow bacterial biofilm to exist in those sealed areas. So, we can seal the area over the fixation screw, but with micromovements between the restoration and implant at the connector due to the microgap, how do we prevent bacteria from growing in those areas and prevent potential peri-implantitis?

Silver nanoparticles have been demonstrated to be a potent and broad-spectrum antimicrobial agent. This has no cytotoxic effect on the metabolic activity of the host cells and is an effective broad-spectrum bactericidal agent, regardless of the antibiotic resistance of the bacteria.

 These particles are smaller than the microorganisms, diffusing into the pathological cells, rupturing their cell walls with no negative effect to the host’s cells.

 Studies have reported that utilization at the implants connector that oral microbiological organisms are inactivated that could be found in the oral biofilm.

 These silver particles do not have a life span and their antibacterial properties remain as long as the particles remain within the area.

SilverPlug® (SilverPlugUSA) was developed utilizing silver zeolite, a naturally occurring substance, in a pliable polymer material to allow adaptation to the area over the fixation screw, adapting to the geometry of the space as it is placed (

). The material has been utilized in the European Union for more than 10 years and has certification as Class IIA material with medical device regulation. SilverPlugwas granted FDA approval in 2022. The SilverPlug does not release silver particles and kills microorganisms that come into contact with it. The silver particles are incorporated into the silver zeolite contained into the medical polymer and do not migrate away from the plug material. Thus, with a dramatic reduction of bacteria present in the area in and around the abutment/implant platform gaps and screw access tunnel, no odor is noted that would be commonly reported when cotton pellets or PTFE are used.

Placement when a screw-retained restoration is being used consists of carrying the SilverPlug to the screw access opening and determining the width needed at that site (

). Length is then determined that will allow 2 mm of composite to be placed over it and be flush with the restoration’s surface; the plug is cut with scissors (

). The piece of cut plug is then carried to the access hole with an explorer or perio probe and inserted into the access hole (

). Cotton pliers can be utilized to hold the plug in the restoration as the explorer/probe is withdrawn. A restorative plugger can be utilized to push the SilverPlug into the access space until it is 2 mm apical to the restoration’s surface (

As the material is pliable, excess can be removed with the edges of the plugger or a diamond bur in a highspeed handpiece so that no material is in contact with the access opening circumferentially in that 2-mm area apical to the restoration’s surface. Similarly, if a cemented restoration is being utilized, the SilverPlug is placed to the superior aspect of the abutment (

Should the fixation screw need to be accessed, removal of the SilverPlug is easy. After exposing the SilverPlug following removal of the overlaying composite or—in the case of a cemented restoration—removal of the restoration, the plug is ready to remove to access the screw. As the material remains pliable, an instrument is inserted into the SilverPlug and it is pulled out of the access area (

If the instrument is having trouble removing the plug, a large (size 45 or larger) endodontic file can be threaded into the plug and pulled out of the area. Removal is easier than removal of a cotton pellet that may leave fibers in the area over the fixation screw’s head or PTFE. The removed SilverPlug can be reused on that same patient should the screw need retightening, or if the restoration is being reinserted at the same appointment.

How to Prevent Peri-Implantitis With Elimination of Cotton Plugs or PTFE

Oral biofilm has a strong connection with peri-implantitis, and those bacteria can be present between the implant and restoration at the connector or over the fixation screw. Utilization of a material that has antibacterial properties, which are present with nanosilver, aids in prevention of active microorganisms in those areas between the implant and restoration that are not accessible with home care. SilverPlug is an easy-to-use material to fill the area over the fixation screw and provide long-term prevention of the issues that contribute to peri-implantitis without affecting host tissues or their normal functions. Its pliable nature allows retrieval should the fixation screw need to be accessed.

Bianco LL, Montevecchi M, Ostanello M, Checchi V. Recognition and treatment of peri-implant mucositis: do we have the right perception? a structured review. 

2021;58(4):545-554. doi:10.17219/dmp/136359

Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. 

. 2018;89(suppl 1):S267-S290. doi:10.1002/JPER.16-0350

Daubert DM, Weinstein BF, Bordin S, Leroux BG, Flemming TF. Prevalence and predictive factors for peri-implant disease and implant failure: a cross-sectional analysis. 

. 2015;86(3):337-347. doi:10.1902/jop.2014.140438

Esposito M, Grusovin MG, Worthington HV. Treatment of peri-implantitis: what interventions are effective? a Cochrane systematic review. 

Hwang G, Blatz MB, Wolff MS, Steier L. Diagnosis of biofilm-associated peri-implant disease using a fluorescence-based approach. 

Lopes PA, Carreiro AFP, Nascimento RM, Vahey BR, Henriques B, Souza JCM. Physicochemical and microscopic characterization of implant-abutment joints. 

. 2018;12(1):100-104. doi:10.4103/ejd.ejd_3_17

Zupnik J, Kim SW, Ravens D, Karimbux N, Guze K. Factors associated with dental implant survival: a 4-year retrospective analysis. 

. 2011;82(10):1390-1395. doi:10.1902/jop.2011.100685

Raab P, Alamanos C, Hahnel S, Papavasileiou D, Behr M, Rosentritt M. Dental materials and their performance for the management of screw access channels in implant-supported restorations. 

. 2017;36(2):123-128. doi:10.4012/dmj.2016-049

Ramidan JC, de Mendonça E Bertolini M, Júnior MRM, Portela MB, Lourenço EJV, de Moraes Telles D. Filling materials efficacy on preventing biofilm formation inside screw access channels of implant abutments. 

. 2022;48(6):573-577. doi:10.1563/aaid-joi-D-20-00191

Ptasiewicz M, Chałas R, Idaszek J, et al. In vitro effects of silver nanoparticles on pathogenic bacteria and on metabolic activity and viability of human mesenchymal stem cells. 

. 2024;72(1). doi:10.2478/aite-2024-0007.

Siddiqi KS, Husen A, Rao RAK. A review on biosynthesis of silver nanoparticles and their biocidal properties.

. 2018;16(1):14. doi:10.1186/s12951-018-0334-5

Matsubara VH, Igai F, Tamaki R, Tortamano Neto P, Nakamae AE, Mori M. Use of silver nanoparticles reduces internal contamination of external hexagon implants by Candida albicans. 

. 2015;26(5):458-462. doi:10.1590/0103-644020130087

A powerful material aids in the fight against peri-implantitis. Read on to learn how to effectively harness this tool.

With new and innovative approaches to dental treatment and practice management being introduced all the time, dental professionals face a challenge when it comes to trying everything and staying up to date. Fortunately, no dental professional faces this challenge on their own. Learn and stay on top of the latest in dentistry with this annual collection of advice from across the industry.

Smooth Transitions

A New Twist on an Established Material

Use Tints to Elevate Single-Shade Composites to High Esthetics

No more “Watch & Wait” with Silver Diamine Fluoride

How best to advance care for treatment of dental hypersensitivity and promote dental health

A New Adjunct Treatment for Periodontal Infections

Achieving Optimal Marginal Integrity With a New Lithium Disilicate Block

Increase Clinical Efficiency With Two Instruments in One Hand

Point-of-Care Testing for Personalized Patient Care

What I Wish Every Dental Professional Knew About Whitening

Unlock Workflow Efficiency by Optimizing Suction Line Health

Making X-ray Aiming Easy

Enhance Your Oral Health Assessments With Fluorescence Technology

Esthetic Enameloplasty With Clear Aligner Treatment

Streamlining Care Through Wireless Innovation

Revolutionizing Case Acceptance and Financial Management in Dental Practices

Instrumental Precision Redefined

Invest in Cutting-Edge Dental Management Software to Transform Your Dental Practice

Increasing Restoration Accuracy With Chairside Milling

Automate Your Front Desk Workflows and Improve Efficiency

Finding the Perfect Mix to Help Perio Patients at Home

Technique Touch-Ups 2024

Dental professionals throughout the industry share their favorite new workflows, technologies, materials, and more.

Lorne Lavine, DMD, founder and president of The Digital Dentist, has more than 30 years invested in the dental and dental technology fields. A graduate of USC, he earned his DMD from Boston University and completed his residency at the Eastman Dental Center in Rochester, N.Y. He received his specialty training at the University of Washington and went into private practice in Vermont until moving to California in 2002 to establish TDD, a company that focuses on the specialized technological and HIPAA needs of the dental community. He can be reached at drlavine@thedigitaldentists.com or 866-204-3398.

Optimizing Operatory Design for Efficiency. Image credit: © BrunoWeltmann / stock.adobe.com


As a systems integrator in the dental field for more than 25 years, I often tell clients that I have “seen it all,” and this is true. In this modern era of identity theft, ransomware, and tons of other pitfalls, I feel genuine concern for my colleagues as the need to protect and secure your data has never been higher. As I mentioned in my previous column, these next few articles are going to focus on the infrastructure that every office needs in place.

One area where I have “seen it all” is in operatory design. I am always amazed that, considering the amount of time most dentists spend in such a small space, many people have not taken the steps to properly plan their operatories for function and efficiency.

It is often not enough to choose a computer based on processor speed or hard drive. Other issues that must be evaluated are the need for DVD players, CD-RW drives, and video cards. Just as important, although often overlooked, is the size and shape of the computer cases. Many offices have cabinets at the 12 o’clock position where an area has been designated for placement of a computer. However, these spaces will not fit all computers, and the dimensions of this space should be evaluated before purchasing the system. Although it would be easy to say offices should simply purchase the smallest case, there are trade-offs that are part of this decision. Many add-on cards, such as those used for video capture and some CBCT systems, will not fit into these smaller cases and therefore will affect which case is chosen. Dentists may also elect to mount their computer systems on a wall or cabinet, although they should understand how much space is required to do this.

The positioning of the monitors is crucial to get the most out of the digital systems in the operatory. The first decision is whether to have 1 monitor or 2 (or more) in the operatory. Many offices are electing to have 2 monitors: one in front of the patient to show digital images, patient education, streaming, or TV, and another behind the patient that can be used to show Health Insurance Portability and Accountability Act–sensitive information, such as the schedule or financial information.

To properly design this, there are certain decisions to make. First, the exact location of the monitor is chosen. In many cases, an articulating arm, such as those from ICW or Ergotron, is used to give the monitor positioning some flexibility. Most offices will mount monitors to the ceiling, light pole, or wall. If mounting to a wall, the location and type of the wall studs will determine how the monitor is mounted. Secondly, there is the concern over cables and cords. Each monitor requires at least a video cable to be run to the computer, and each requires electricity. Because most dentists do not want to see multiple cables snaking across the floor and walls, it is often a challenge to determine the best way to run these cables and end up with a visually pleasing solution.

Although touch screens are an option, their cost often makes them prohibitive for dental offices, so most dentists still prefer to have a mouse and keyboard to input data. Wireless devices are almost mandatory in the operatory, but the positioning remains important. If the dentist or staff member must twist their body to use the devices, back and shoulder problems can develop rapidly.

Although the digital dental operatory is evolving, dentists should understand that many minor issues need to be addressed in the planning stages to get the most benefit from their new systems.

Dental operatories are the heart of the practice, so it is vital that key details and technologies are implemented to ensure efficiency and function.

Optimizing Operatory  Design for Efficiency

Edward Kusek, DDS, stands out as a leading dentist in Sioux Falls, South Dakota, and uses the latest in dentistry techniques to provide patients with beautiful and healthy smiles. Additionally, he believes strongly in education to prevent oral health problems before they occur and makes sure to keep patients fully informed about their dental health. Dr Kusek is a general dentist and is truly compassionate about continuing education and offering his patients the latest advancements in general dentistry. He is a clinical instructor for Straumann (implant dentistry training) and Ultradent (laser training) and an instructor for GPT (Greater Plains Technologies) laser dentistry.

Photobiomodulation (PBM) has been used clinically in treating the temporomandibular (TMD) joint for more than 30 years. PBM has been increasingly used in other countries but is not as widely used in the US for TMD joint pain. PBM uses light energy to repair damaged areas for a patient.

PBM is like photosynthesis in plants but uses certain wavelengths of light in the red and infrared spectrum (the ideal range is 660-840 nm). PBM causes intracellular photochemical changes that lead to a cascade of downstream intracellular photochemical, extracellular, and physiological changes. The mitochondria within the cell wall are particularly receptive to this process. At the cellular level, visible red and near-infrared light energy is absorbed by mitochondria, which produce cellular energy called adenosine triphosphate (ATP).

PBM’s use in treating the existing TMD joint and/or pain and dysfunction in masticatory muscles impacts the biological process, especially inflammation, and is considered an adjunct treatment modality in TMD cases.

This article will focus on the use of PBM to aid in the dysfunction of the TMD joint. PBM will aid in decreasing inflammation in the joint, increasing endorphins associated with masseter muscle, and the stimulation of acupuncture points (an Eastern medicine). PBM can stimulate the acupuncture areas; this is called photoacupuncture (combination of 

). The World Association for Photobiomodulation Therapy defines 

 as “photonic stimulation of acupuncture points and areas to initiate therapeutic effects like that of needle acupuncture and related therapies together, with added benefits of PBM.” Photoacupuncture helps to repair the physical dysfunction, relieves pain, and aids in the comfort of the patient.

When treating patients, the first procedure is to document the maximum opening without pain (

). You can use this device or your fingers to measure the opening from the maxillary incisors to the mandibular incisors (

). The patient should be able to open to 3 fingers’ width. The mean opening in a study done by Zawawi et al was around 48 mm.

Next, use photography to document the area in the masseter that creates the most pain (

). By documenting this area, auxiliaries will be able to make quick reference to the site of the masseter that creates a trigger spot for pain during function just by touch. During the first session you will want to overstimulate the site to get pain relief (release the body’s endorphins). This site is normally treated with 12 to 15 J of energy as shown with a 1-minute duration using a 25-mm extraoral device (Ultradent Products’ Gemini 810 + 980 diode laser with PBM attachment; 

. Cell physiologists have shown that use of 4 to 6 J of energy produces healing amounts of light energy, whereas using more than 12 J overstimulates the pain receptors.

As discussed earlier, stimulation of photoacupuncture points also stimulates the area around the ear (

), but this is done with 4 to 6 J of energy to each site. These areas need to be treated at each visit with the same 4 to 6 J of energy.

The other stimulation sites are the lymphatic sites in the head and neck areas. TMD creates inflammation in the joint, so by treating the lymphatic system, you can reduce inflammation in the head and neck area.

Treatment of the submandibular and the subclavicular lymphatic ducts with 4 to 6 J of energy at each site will need to be done during each visit (

). Using this regimen every 4 to 5 days between sessions brings the most optimal results, with the only change being to stimulate the trigger point in the masseter with 4 to 6 J of energy after the first session.

Using Photobiomodulation to Ease Temporomandibular Pain

The treatment is not a one-and-done procedure, as it must be done for 1 session after the patient states they have significant reduction of pain and mobility to allow normal opening of the mouth without pain (6-8 sessions). The patient may have several months of relief until stress creeps back into their life and they begin overfunctioning and stressing the TMD area.

Many insurance companies cover the expense of this treatment, which we charge at the first session and do not charge anything further to prevent patients from stopping treatments early due to concerns about cost. Insurance codes used are D7899 (unspecified TMD therapy, by report) and D9130 TMD (noninvasive physical therapy). Another dental code that can be used is D9110 (palliative emergency treatment of dental pain). Unfortunately, insurances rarely pay using this code. For medical coding, use 97032 (electric stimulation, manual, each 15 minutes) if you have the capability to submit by these means.

Following this treatment plan works well but requires patient adherence to the number of visits needed for success. Let patients know up front that you cannot guarantee success, but the resolution of limited opening and related discomfort should be possible—especially if the patient changes habits, such as refraining from chewing gum and eating chewy foods like submarine sandwiches or bagels that put stress on TMD joints.

Some may still consider this hocus-pocus dentistry, but it does work and there are numerous articles in PubMed showing PBM makes a significant difference.

 One great resource for learning more about PBM treatment is the Academy of Laser Dentistry. PBM does work and has many uses in dentistry and in medicine.

Clinical images courtesy of Dr Edward Kusek. 

Azeemi STY, Rafiq HM, Ismail I, Kazmi SR, Azeemi A. The mechanistic basis of chromotherapy: current knowledge and future perspectives. 

2019;46:217-222. doi:10.1016/j.ctim.2019.08.025

Sun G. Photoacupuncture: combining Eastern and Western medicine for integrative healing. Academy of Laser Dentistry. November 2023. Accessed May 6, 2024. https://www.laserdentistry.org/index.php?option=com_dailyplanetblog&view=entry&year=2022&month=11&day=22&id=36:photoacupuncture-combining-eastern-and-western-medicine-for-integrative-healing

Zawawi KH, Al-Badawi EA, Lobo SL, Melis M, Mehta NR. An index for the measurement of normal maximum mouth opening. 

Madani A, Ahrari F, Fallahrastegar A, Daghestani N. A randomized clinical trial comparing the efficacy of low-level laser therapy (LLLT) and laser acupuncture therapy (LAT) in patients with temporomandibular disorders.

 2020;35(1):181-192. doi:10.1007/s10103-019-02837-x

Xu GZ, Jia J, Jin L, Li JH, Wang ZY, Cao DY. Low-level laser therapy for temporomandibular disorders: a systematic review with meta-analysis. 

. 2018;2018:4230583. doi:10.1155/2018/4230583

Photobiomodulation and light have a variety of uses, including for temporomandibular joint pain that many patients experience.  

Using Photobiomodulation to Ease Temporomandibular Pain 

Tameko Sowell, DDS, is a native of Ohio, where she earned her bachelor’s and master’s degrees in human nutrition and food management from The Ohio State University. She obtained her dental degree from New York University in 2007. While in dental school, Dr Sowell participated in multiple outreach programs, including mission trips to Nicaragua and Tanzania. After obtaining her dental degree, she completed a 1-year advanced education training with the US Department of Veterans Affairs in Bay Pines, Florida. Dr Sowell began working for Gaston Family Health Services in 2008 (which became Kintegra Health in 2020) as a staff dentist and became assistant dental director in 2016. In January 2024, she became the chief dental officer of Kintegra Health and oversees the dental department. Dr Sowell enjoys working in the public health sector and believes dentistry is her calling to give back to the community.

With the help of technology, the programs are on their way to delivering whole-person care and establishing a higher level of clinical excellence to their patients. | Image Credit: © Kintegra Health

Kintegra Health is a federally qualified health center. Specifically, we are a community-sponsored, family health–centered health care organization that offers treatment, education, and preventive services regardless of a patient’s ability to pay. More than half of our patients are under Medicaid, and the rest are self-pay and private insurance patients.

Kintegra’s origins go back to 1989 in Gastonia, North Carolina—the result of the formation of a local task force of concerned citizens, business leaders, and representatives from our local hospital. The task force was formed to address the concern that our town’s growing uninsured population was frequently using the local hospital’s emergency department to obtain primary medical and dental care. This task force was the catalyst for the formation of Gaston Family Health Services (GFHS).

In 1992, we saw our first medical patient, and then we added dental services in 1996. Our current services are much more holistic and include adult and pediatric primary care, behavioral health, pharmacy services, chiropractic, and podiatry. We will be adding optometry to our school-based programs in 2024.

In April 2020, we rebranded GFHS as Kintegra Health. We made the change to better represent our growth in multiple counties outside of Gaston and our expanded comprehensive and integrated health care services.

When the COVID-19 pandemic struck in the middle of our rebrand, we did not know what to expect or how we were going to continue caring for the underserved community that had been depending on us for health care services. We certainly did not want to see a return to the situation that prompted our formation in 1992—overwhelming the local emergency department. We knew we had to be innovative once again.

After much thought, we decided to take a virtual patient care approach and implement digital imaging and teledentistry. Within the first few months of the pandemic, we equipped the public health hygienists on our mobile dental units with teledentistry-enabled MouthWatch intraoral cameras and never looked back.

We standardized MouthWatch cameras because they came highly recommended by Kintegra Health Dental Director Bill Donigan, DDS, MPH, who had been using them in his private practice for years. It had been his idea to equip Kintegra’s medical providers with intraoral cameras.

MouthWatch has its own award-winning teledentistry software named TeleDent, but its intraoral cameras integrate well with about any teledentistry platform. Because most of our providers were already familiar with Microsoft Teams, we integrated the cameras with that platform to fast-track the teledentistry program during the pandemic and ensure its widespread adoption among our dental and medical providers.

Kintegra Health has its medical and dental providers and its front office personnel as part of our workflow, so having the ability to close the medical-dental loop very quickly when patients seek care is a great advantage. By using the MouthWatch camera with Microsoft Teams, we were able to easily integrate intraoral images into our existing medical-dental collaborative workflow. Here is the medical-dental referral process:

If a patient complains of pain or has oral health concerns, the medical provider will request that their medical assistant take intraoral photos with the MouthWatch camera.

The medical assistant then makes a dental referral in their electronic records (which is Epic to dental), and the intraoral images are uploaded into a transfer file that the medical and dental teams can access.

The medical assistant then sends a Teams message to the dental provider, who will respond with a patient urgency-of-care assessment of level 1, level 2, or level 3.

Level 1 signifies that the patient needs to be seen within 24 to 48 hours and that the patient is expressing a pain level of 9 or 10 (the dental provider includes this in a report shared with medical).

Level 2 indicates the patient could wait to be seen within a week.

Level 3 means the patient’s dental appointment can be pushed out further, within 2 weeks.

This process is similar but reversed as the referral is from medical to dental in these cases.

Since we adopted this workflow, the feedback from our medical providers has been positive. They are frequently surprised by how quickly we can get their patients’ intraoral images reviewed by our dental providers and scheduled for treatment if necessary.

: Kintegra Health, formerly known as Gaston Family Health Services, uses teledentistry to allow a medical-dental collaboration that in turn helps close the medical-dental care gap and assist more patients.

This quick collaboration is made possible with teledentistry, whereby we conduct an initial evaluation and create a treatment plan that we can present when the patient or patient and guardian come to the clinic. Very often when the medical and dental teams work in the same location, we can start dental treatment the same day, which is not only convenient for the patient but quickly closes the loop with our medical providers.

We had a 5-week-old being seen in one of our pediatric offices. The pediatric medical team sent an intraoral photo of an eruption cyst to one of our pediatric dental providers in the same building. She was able to walk to the medical office within minutes and give that mom peace of mind by letting her know that the eruption cyst would dissolve on its own and there was nothing to worry about.

A child with lymphadenitis had an abscess associated with the stainless steel crown on a primary molar. Medical and dental teams agreed to send this patient to the emergency department immediately so he could receive intravenous antibiotics. He returned to the dental clinic a week later for extraction of that abscessed primary tooth. This was an example of optimal care for that patient because we were able to agree to send him to the emergency department right away and not waste time having him come to the dental clinic first.

In another instance, our pediatric medical facility forwarded a photograph to our dental team. Nearly every tooth in this child’s mouth had decay. Although the original photo was just a broad-spectrum picture of the mouth, the dental team took more photos to demonstrate how bad the patient’s oral health was. In addition, this child had a cardiac episode. Thanks to teledentistry and our patient navigator, we were able to virtually refer that child from the pediatric medical clinic to a pediatric dentist who looked at the data and responded within a half-hour. The good news was the child never had to leave the medical clinic for the dental evaluation, and the cardiac referral received top priority and was processed the same day.

Some cases are more troubling. Our dental team recently received an intraoral photo taken at one of our schools, and the child had a papilloma on his palate. Coincidentally, our dental team had recently attended a lecture regarding how to identify the signs of child abuse during oral examinations. We immediately turned this case over to our Department of Social Services. If we were not taking intraoral photos in the schools, this incident would have been missed and that child would still be enduring sexual abuse. Thanks to digital imaging and teledentistry, Kintegra Health can be an active advocate for child safety in every community we serve.

When we started the medical-dental integration program, we were not sure how it was going to unfold or what the response among our medical and dental providers would be. Fortunately, our medical and dental teams have been very receptive. I was not surprised about the support among dental providers, as they are taught in dental school to touch every single tooth.

I was, however, pleasantly surprised when some of the medical providers said to me, “Hey, we never really referred to dental because we never knew if our patients were actually seen.” Once we were able to get our medical providers excited, Kintegra Health was well on its way to delivering whole-person care and establishing a higher level of clinical excellence for our patients—and we are keeping them out of the emergency department.

With the help of MouthWatch, Kintegra Health is working to close the gap between medical and dental care and has collaboration success stories that show how it is keeping patients out of the emergency department. 

Deep Dive: Establishing Better Physician-Dentist Collaboration With Technology

John Flucke, DDS, is in private practice in Lee’s Summit, Mo. He also serves as chief clinical editor and technology editor for 

® and keeps an active blog filled with thoughts and tidbits on the world of technology at blog.denticle.com.

AdDent’s Compex HD features a warming unit built into the barrel that heats the composite compule in the gun. | Image Credit: © AdDent 

In my years of being Technology Evangelist, I have gotten to work with some amazing products and collaborate with some amazing people. As an industry, we are lucky to have these individuals in the world of research and development. We count on them to deliver us state-of-the-art tools, supplies, and materials that allow us to do better in helping patients.

Dentistry is a huge industry. Because of that, we benefit immensely from all types of companies that support us. Large multinational companies, medium-sized operations, and smaller companies provide us with things we use every day that improve the lives of our patients. As a tech lover, I see and use the benefits of all types of their hard work. This month, I would like to highlight one of those smaller companies that gives us big benefits. That company is AdDent in Danbury, Connecticut.

The company was founded by Josh Friedman, DDS. He is one of those individuals who quietly work behind the scenes, but we all benefit from what he has created. I do not remember the first time I met him, but what I do remember was realizing he is an “outside the box” thinker.

The industry is fortunate to have many great minds developing products and techniques that help clinicians perform better dentistry.