Annemarie Mannion

Sugar-free lollipops containing licorice root extract significantly reduced the bacteria that causes tooth decay, specifically among pre-school children with high-risk of tooth decay, according to a recent study published in the European Academy of Pediatric Dentistry.

The study, funded by the Research and Data Institute of the affiliated companies of Delta Dental of Michigan, Ohio, Indiana, Tennessee, Kentucky, New Mexico and North Carolina, analyzed 66 preschool students ages 2 to 5 enrolled in a Head Start Program in Lansing, Mich. For three weeks, each student received an orange-flavored, sugarless lollipop for 10 minutes, twice daily.  

Researchers said they were motivated to conduct the survey by the high number of children who face dental decay and cavities. According to Jed Jacobson D.D.S., M.S., M.P.H., chief science officer at Delta Dental, dental decay is one of the most common childhood diseases, with more than half of children ages 5 to 17 having had at least one cavity or filling.

"We are working to find simple, effective regimens that will encourage prevention and control of dental disease,” he said.

Study results showed a significant reduction in Streptococcus mutans (S. mutans), the primary bacteria responsible for tooth decay, during the three-week period when the lollipops were being used and lasting for an additional 22 days before beginning to rebound.

Using a saliva test, the amount of S. mutans in the patient's mouth was measured before and during the three-week period where lollipops were used, as well as for several weeks thereafter.

Jacobson said that while children identified as being at high, moderate and low risk participated in the study, the most significant drop in S. mutans was among those children at high risk.  

“If there are more S. mutans [in a child’s mouth], then it’s going to have a greater reduction because there are more to kill,” Jacobson said.

Licorice root was used in the study because it has already been identified in lab settings as effective at fighting the S. mutans, and as an old Chinese herbal extract, it’s a natural flavor used for sweetening, Jacobson said.

Teresa Spitzer, R.N., Health Programs Manager for Capital Community Head Start Inc., said her organization was excited to be part of the study.

"Staff and parents were intrigued by something as simple as a special lollipop having the ability to decrease the incidence of dental caries in children,” she said. “The outcomes only reinforced the value the parents placed on the project."

Though more research is needed, Jacobson said the children liked the taste of the lollipops, and he could envision them being used to supplement other oral healthcare hygiene habits, such as brushing teeth and flossing.

“Children don’t exactly rush to brush their teeth at night and in the morning,” he said. “This could help get around those behavioral hurdles.”

The next step that Jacobsen said he would like to see is further research to confirm or disprove the results.

“We’re publishing and promoting this study in hopes that other scientists will continue and expand on this pilot,” he said.

The lollipops, manufactured by Dr. John's Candies of Grand Rapids, Mich., were developed using FDA-approved materials by Dr. Wenyuan Shi, a microbiologist at the University of California – Los Angeles (UCLA), and C3 Jian, Inc., a research and development company in California.

There are approximately 700 types of bacteria in the human mouth. While most are harmless, S. mutans is considered the primary culprit in tooth decay. They live in a biofilm (plaque) that adheres to the teeth, consume sugar and release acid that erodes tooth enamel, causing decay. Regular brushing and flossing, along with dental checkups, can help keep S. mutans and Lactobacillus casei in check.

Articles

Licorice lollipops keep teeth jolly

	The first study using an atomic-scale imaging tool to look at the chemical structure of a sea creature’s tooth has important implications for human dentistry including the potential for creating better, stronger materials for tooth replacement and for treating flouritis.

	Two researchers at Northwestern University, who released their results in January, used atom-probe tomography to study the teeth of a tiny sea creature, an Eastern beaded chiton. They created a three-dimensional map identifying the location and identity of millions of atoms that make up the tiny creature’s teeth.
	
	The sea mollusk has teeth that are similar to human teeth in significant ways. Both have a hard outer layer, like enamel, and a soft core.
	
	“The general structure of the tooth is reminiscent of human teeth,” said Dirk Joester, who was lead author of the paper and is the Morris E. Fine junior professor in material and manufacturing at the McCormick School of Engineering and Applied Materials.
	
	The chiton’s outer layer is composed of magnetite, a tough iron oxide that gives the teeth a black sheen. The marine creature feeds on algae that grow on rocks and, in a manner comparable to a conveyor-belt, it creates a new row of teeth every day to replace older, worn teeth that are moved out of the way.
	
	The ability to see new and mature teeth made the chiton an ideal subject to study.
	
	“You can go back in time and see the (older) teeth,” said Joester. “Each row is less mineralized. It gives us a picture of the entire development of the teeth.”   
	
	Joester, along with Lyle Gordon, a doctoral student in his lab, were able to locate organic fibers hidden in the magnetite. The map revealed the first direct proof that carbon-based fibers, each between 5 and 10 nanometers in diameter, also contain either sodium or magnesium ions. The team also was the first to demonstrate proof of the location, size and chemical composition of the organic fibers inside the mineral.
	
	Joester said being able to understand the architecture of teeth on a nanoscale, and how inorganic and organic materials interface, will lead to the creation of more resilient tooth replacement materials. Those materials will combine the best properties of organic and inorganic materials.
	
	“If you can understand biological materials than you can reverse engineer a solution,” he said.
	
	He also said it may allow for better treatment of an increasing problem, flouritis.
	
	“Flouritis is really on the rise, but it’s poorly understood,” he said. “We’ll be able to better understand how fluoride moves around the teeth and see it at a much higher resolution.”
	
	Other applications include the tracking of cancer and osteoporosis drugs in the bone.
	
	Joester said he is currently is using atomic-scale imaging tools to study the teeth of rats and pigs and expects to have results in about a year.

 The first study using an atomic-scale imaging tool to look at the chemical structure of a sea creature’s tooth has important implications for human dentistry including the potential for creating better, stronger materials for tooth replacement and for treating flouritis.

Can a sea mollusk's teeth aid in design of materials

	Sandy Smith, a dental hygienist in Ohio, felt she had no other option last August but to quit the part-time job she had held for 22 years, and liked doing. She left because she had learned that the dentist with whom she worked had become addicted to narcotics.

	"We did IV sedations,” she said. “So there was access to Valium and Demerol and that’s pretty much what he was using.”
	
	Dentists have more access to drugs than the general population and that may fuel speculation that use of drugs and alcohol is more prevalent among them than the general population, but a recent study has shown that isn’t the case.
	
	“There is little evidence that dentists are at a greater risk of developing alcohol-or other drug-use problems than is the general public,” concludes a study co-authored in 2005 by George Kenna, which analyzed the prevalence of alcohol, illicit drug and cigarette use among 113 dentists.
	
	As Smith’s story shows, however, drug addiction can surface in a dental practice and become a potentially devastating issue not only for the dentist, but staff and patients.
	
	Smith, whose name has been changed to protect her privacy, said the dentist’s addiction, and the way the situation was handled, is still distressing for her nearly a year later.
	
	“It turned my life upside down,” she said. “I wasn’t prepared for it.”  
	
	Kenna, a professor of psychiatry and human behavior at Brown University, agreed there is no easy way for an employee to handle such a difficult situation.
	
	“You feel like you’re going to get fired if you confront the person, but you end of getting fired anyway if the practice is harmed,” he said.   
	
	In her case, Smith said she went to work one day last summer and learned that the dentist had collapsed the day before, and paramedics had been called.
	
	“That was when things came to a head,” she said. “I went in and I was greeted with “We don’t have a doctor today.’”  
	
	Because she worked part-time and didn’t have frequent interaction with the dentist, Smith said she was surprised to find out that he had become addicted to painkillers.
	
	She said other employees discovered the evidence in his office.  
	
	“They found a tourniquet and syringes in his private bathroom and there would be no reason for those to be there,” she said. “They also found an open bottle of Demerol and a shipment of Demerol in his office.”
	
	Because the dentist had always displayed a somewhat moody personality, she said any drug-related changes in his personality had gone unnoticed. He also had always been an upstanding member of the community.
	
	“He could fly off the handle,” she said.  “But he was the last person I’d ever would have thought would do this. That’s why none of us suspected.”
	
	When the dentist returned a couple days after collapsing to resume his practice, Smith said she had a choice to make.  She didn’t think she could work there anymore and her husband, a police detective, agreed.
	
	“He said, ‘You can’t work there anymore. You’ll never trust him.’”  
	
	Though it may be because her husband is on the police force, Smith said she also felt deeply hurt by other hygienists who she believed froze her out, and didn’t want to tell her about the dentist’s problem.
	
	She recalled that one person approached her the day after the collapse  to tell her about the discovery of the dentist’s addiction and said, “I’m not supposed to tell you this but I am going to because I wouldn’t want something to happen to your  (dental hygiene) license.”
	
	Smith believes that informing the dentist that she was quitting and that she planned to cite the reason as his addiction when she applied for unemployment frightened him and forced him to take action. He voluntarily contacted the state dental board and told them about his problem, and went into 30-day rehab.
	
	Kenna, whose wife is a dental hygienist, said he does not believe Smith was in jeopardy of losing her license “unless she was complicit in the act (of using drugs).” The Ohio State Dental Board did not return calls for comment.
	
	Unfortunately, other than leaving the job, Kenna said there may be few options for people who find themselves in a situation like Smith’s.
	
	“The best way to handle the problem is to start looking for another job,” he said. “But the brave thing to do is to bring it to the dentist’s attention.”
	
	Months after making her decision to quit, Smith has found another part-time job, but she said it was difficult to land one in this slow economy. She also that the dentist she worked for has returned to practice, and has brought another dentist into the business.
	
	Her former boss, however, has not contacted her.  She feels an apology from him would help her move on emotionally.
	
	“I’m struggling to try to forgive him. I’m kind of in limbo,” she said.  
	
	Though other hygienists continued to work in the practice even after the addiction became known, Smith said she thinks she did the right thing, and her decision to quit forced the dentist to get help.
	
	“If my quitting pushed him to get help then I’m glad I did it,” she said.
	
	“She should be proud of what she did,” added Kenna. 

  Sandy Smith, a dental hygienist in Ohio, felt she had no other option last August but to quit the part-time job she had held for 22 years, and liked doing. She left because she had learned that the dentist with whom she worked had become addicted to narcotics.

Do you work with a drug addict?

Ronald Reagan was president and David Letterman’s “Late Show with David Letterman” aired for the first time in 1982, the year Monique Judkins was licensed as a dental hygienist.

Fast forward to 2002 when George W. Bush was in the White House and the first American idol star Kelly Clarkson was topping the pop charts. That’s when Judkin’s sister, Christie Schlesinger, joined the profession.

Now a third sister, Bevin Houston, who had worked as a dental assistant, is finishing her studies and preparing to become licensed.
	
	Having three sisters in the same profession is not without precedent. Just ask those singing Andrews sisters. But these sisters believe it’s unusual. 
	
	“I think two sisters (in dental hygiene) is not uncommon,” said Schlesinger. “But three? I’ve never heard of three before.”
	
	Like peeling back the layers of bark in a tree, the sisters have been witnesses through time to the way the field has evolved. Judkins, who lives in Orofino, Idaho, said increased awareness of the importance of infection control is one way it has changed.
	
	“Back in 1982 not all dentists were wearing masks and gloves,” said Judkins who earned her degree at the Oregon Institute of Technology in Klamath Falls.
	
	Other important ways in which it has changed include the awareness of how oral health impacts the entire body, and in the development of new tools for fighting disease. 
	
	“There’s more knowledge of the link between bacteria in the mouth and how it can increase your chance for disease,” said Judkins. “Having your teeth cleaned isn’t just to make them pretty. It affects your health.”
	
	According to Judkins,  it used to be that teeth cleanings once a year was the standard recommendation for all patients. Now cleanings may be recommended a minimum of four times a year for patients dealing with other health issues such as diabetes, smoking or a low immune response. There also are new tools for promoting oral health such as lasers to treat gum disease. 
	
	Keeping up with continuing education and changes in the field is a challenge that Judkins likes about being a dental hygienist. She got into it because of a high school aptitude test – and because of her mother.
	
	“My mother had recommended it,” Judkins said. “And I did some aptitude testing and I scored high on finger dexterity and eye/hand coordination.” 
	
	Her sister Christie’s decision to become a hygienist came much later and was the result of a desire to change careers. She had worked as a nutritionist, but was drawn to dental hygiene because of its emphasis on prevention. She earned her degree at Lane Community College in Eugene, Ore. and got her license in 2002.
	
	“I’ve always loved the preventative aspect of it,” Schlesinger said. “The more I learned about it, the more I knew I wanted to do it.”
	
	Schlesinger likes teaching her patients about the importance of taking care of their oral health. She said it also enables her to share her knowledge of nutrition.
	
	“I counsel them in nutritional awareness and it’s really effective,” she said. 
	
	Demonstrating how she incorporates her knowledge of both fields, Schlesinger said she asks patients about what they eat and has encountered diabetic patients who skip breakfast. She talks to them about how they can avoid dips in sugar levels by simply slathering peanut butter on toast or grabbing some string cheese.
	
	She also delves into other significant health issues that diabetic patients may face.
	
	“If someone has diabetes they really at risk of periodontal disease,” she said. “That’s something I talk to them about.”
	
	According to Judkins, non-surgical periodontal therapy is now that standard and wasn’t in existence when she did her training.
	
	“They only did surgical therapy back then,” she said. “Now we incorporate antibiotics under the gumline. That wasn’t invented probably (until the mid-1990s) when my sister Christie graduated.”
	
	While playing a role in prevention was Schlesinger’s motivation for entering the field, her sister, Houston, had already worked for seven years as a dental assistant before she decided she wanted to expand her knowledge and become a hygienist.
	
	She also likes interacting with patients.
	
	“I’m pretty outgoing. I’ve always known that I want to work with people,” she said.  
	
	Now working toward an associate’s degree at Carrington College in Portland, Houston said she will also pursue licensure in restorative work, which will enable her to place amalgam and composite fillings.
	
	“It makes you more valuable,” she said. “It will give me another marketable skill.”  
	
	Houston said having her sisters involved in dental hygiene has helped her network and get to know others in the field. The trio also have one other to turn to when they need to vent after a hard day.
	
	“It can be emotionally draining,” said Schlesinger. “Because we’re seeing patients who are in pain.”
	
	They also find that the field is physically demanding.
	
	“It’s a career where you can have back, neck or wrist problems,” Schlesinger said. “You really have to be in good shape to be a hygienist.”
	
	It’s not unusual, the sisters acknowledge, for them to spend time talking shop. They also will meet for continuing education classes. As testament to their interest in health,  Judkins and Schlesinger even trained together for a marathon a few years ago, and spent much of the time with phones at their ears as they ran.
	
	“I talked to Monique a lot,” Schlesinger said. “We’d talk about interesting cases we’d seen and about what we’ve learned in (continuing education) classes.”
	
	Though each got into the field for somewhat different reasons and in different phases in their lives, they agree that have something in common besides being siblings. Providing the best patient care is what keeps them motivated.
	
	“I like the connection with people,” said Judkins. “And helping them see the value of keeping healthy.”

The hygiene trio sisters

While he was watching the late night television news broadcast in Chicago recently, cosmetic dentist Jack Manikowski was touched by the story of an 18-year-old man who had been bruised and bloodied while being dragged along the street during a carjacking. The victim also suffered several broken teeth.

Manikowski was eating dinner with his wife, Lana, when he saw the story, and knew he wanted to help. 

“He was an innocent victim,” said Manikowski, owner of 

 in Chicago. “He had his hand over his mouth when he was talking and you could tell his mouth had been injured.”

In October, the young man, Edwin Rodriguez, was in a car waiting for his brother to get off of work at a hotel in Chicago when someone came up to the car and told him the vehicle had a flat tire. When Rodriguez got out to look, one of the thieves allegedly got in and began to drive away. Rodriguez grabbed the door and was dragged a city block before he was able to let go.

Seeing the young man on T.V., Manikowski was not sure if Rodriguez covered his mouth because he was in pain or was embarrassed about how his broken front teeth now looked. After learning a bit more about Rodriguez through stories in the media, Manikowski reached out to him and made an offer to help the young man restore his smile.

“He comes from a very nice, hardworking family that clearly didn’t have the means to take care of a cosmetic problem,” the dentist said.

At the first appointment, Manikowski discovered that teeth 7, 8 and 9 had been severely fractured, but were still vital. He estimates that it has taken 8 hours of work over three appointments to fix the broken teeth.

“The treatment was scaling and root planing and subsequently one long appointment for direct bonding," Manikowski sasid. "Fortunately, he didn’t need implants or any interdisciplinary intervention.”

Manikowski, who has been in practice for 15 years, has previously volunteered to help restore the smiles of women affected by domestic abuse through the American Academy of Cosmetic Dentistry’s Give Back a Smile program. He said it’s not unusual for dentists to encounter patients of limited means, and he was glad this time to be able to help a young person who needed it.

“We all see patients that don’t go through with treatment because of a lack of financial resources,” he said. “But (this case) looked like a slam dunk cosmetic case. It could be an immediate fix.”

After learning of Manikowski’s offer, Rodriguez said in a local television news story that he was overwhelmed by the dentist’s desire to help him.

"I'm speechless because I didn't think anybody would offer me anything. I'd like to say 'Thanks' to him and I appreciate it a lot,” Rodriguez said.

Chicago dentist provides carjacking victim with new smile

When a tornado tore through Joplin, Missouri on May 22, 2011, it destroyed 23 of the town's dental offices, and left four dentists homeless.

Recovery from the horrific event that affected 40 percent of the community’s dental practices has not been easy, but the 

 has taken a leadership role in helping those dentists return to treating patients and running their businesses.

The association not only documented victims’ personal stories of the destruction in its members’ newsletter, but has been there to do something it had never prepared for: coordinate a tornado response effort.

Paul Roberts, director of advocacy and outreach for the association, had only been on the job three weeks when the tornado hit. After the magnitude of the disaster was realized, he helped create a document outlining the association’s tornado response effort and it shows how the disaster thrust the dental association into a role it never had planned on taking.

According to the document, “this project was not anyone’s calendar prior to late Sunday evening, May 22, 2011.” No organization charts or job descriptions were in place. There was no ‘tornado response’ budget. Yet, it became imperative to figure out the best way to respond swiftly and to identify and provide needed assistance to the dental community.”

Most of the dental practices that were affected by the storm were in the area of St. John’s Hospital in Joplin.

“The tornado cut a half-mile to three-quarter mile wide and six-mile-long path,” said Roberts. “It moved through Joplin like a lawnmower.”

To help dentists recover, the association first needed to assess the damage that was caused. It was learned that 27 active or retired dental offices were destroyed and 23 of those were MDA members. 

The association dedicated a page on its website to providing information about assistance from the Federal Emergency Management Agency, Small Business Association loans, licensure and healthcare provider information, and city regulations. A resource page also was established to post all non-financial sources of help such as supplies or donated equipment. Applications for urgent financial assistance also were posted on the website. 

“We need to provide centralization of logistics so when news came in they’d (dentists) get it,” said Roberts.

Within the first ten days following the tornado, the MDA held its first meeting on-site with dentists in Joplin.

“Our members were stunned, but engaged,” wrote Roberts. “We gathered valuable information and started to address their most pressing need: Help me get back to work.”

A local leadership team was put in place and a staff member from the MDA assigned to it. Every dentist affected by the tornado was called directly for an assessment and an assurance that the association was there to help.

The association has been able to assist dentists to cope with breaches in Health Information Privacy rules when records were strewn over a vast area. There is a legal requirement that patients be informed when a breach of their records has occurred and the association was able to help dentists with that.

“We were getting calls (about found records) from six counties away,” said Roberts. “We acted on behalf of the dentists. We ran ads telling patients that your records may have been compromised.”  

If the association had not run the ads, Roberts said each dentist would have had to write a letter to each of their patients about their records being breached.

“This (the ads) saved members untold time, expense and stress during a chaotic time,” Roberts wrote.

The association also started a disaster relief fund and has accepted applications to review how to distribute more than $175,000 in financial assistance to dentists.

“There was an outpouring of funds and donations,” Roberts said. “We started a disaster relief fund and have been dispensing it based on need.”

Roberts said dentists immediately had to consider all options and start making decisions about how they would continue their practices whether that meant finding new space, renting a trailer, or even relocating to another community.

He is happy to report that none of the affected dentists have moved out of Joplin due to the tornado. 

“No one decided to leave as far as we are aware,” Roberts said. “And there’s has not been an issue of patients not receiving care.”

He said the association has placed ads in local newspapers to promote dentists’ new office locations and ran a continuing education workshop to help dentists address their needs and practice management decisions in light of the disaster.

Roberts said dentists in Joplin are getting back on their feet.

“Everytime we go down there the spirit has been better and better,” he said.

There was no budget or outline for how the MDA would help affected dentists, and there is no deadline for when the assistance will no longer be needed. Although life will never be like what is was before the tornado, Roberts said he and other members of the MDA are happy to see dentists return to doing what they love.

“Life is not normal, but dentists are once again doing what they love to do-serve the public and address oral healthcare in their community,” he wrote.

As a result of the tornado, Roberts said the MDA has created new forms, procedures and resources to assist when disaster strikes. Setting up such a large charitable effort was one of the small association’s large challenges.

Roberts said, however, that “it sets up the MDA to better serve members after future natural disasters” and the association will continue to share and learn from “lessons of heartbreak and healing.”

When a tornado tore through Joplin, Missouri on May 22, 2011, it destroyed 23 of the town's dental offices, and left four dentists homeless. Recovery from the horrific event that affected 40 percent of the community’s dental practices has not been easy, but the Missouri State Dental Association has taken a leadership role in helping those dentists return to treating patients and running their businesses.

Rebuilding after devastation

Call it cheeseburger in paradise, movie mania, hot rod heaven or a yearning for yesteryear. No matter how you label it, David Myer’s orthodontic office, which is designed to look like a 1950s gas station/soda shop/old-time movie theater, makes visits for young patients more fun.

“When new patients come in the staff gives them a tour,” said Myers. “They just go ‘Wow. This is so cool.’ And they take pictures and post them on Facebook.”

From the reception desk designed to look like a vintage woodie wagon to the 1956 pink Cadillac turned into a couch, to the movie marquee where patients’ names are in lights, the 3,600 square foot office in Conway, Ark. takes the Wow factor to a whole new level.

It’s where Myers, who admits to being a cool car fanatic, is able to indulge his interest in hot rods and display his collections.

“I’ve been a car nut and an orthodontic nut since I was 6 years old,” said Myers. “I liked going to the dentist and I liked playing with mechanical things – cars, trains, remote-control planes, but mostly cars.”

Myers, who moved into the new office about a year and a half ago, wanted anything but bland and boring for his new place. He hired an architect to create the floor plan, but did much of the work to make it unique including restoring cars and building his own custom furniture.

Myers, with some help from his father, made two couches --one from a 1956 Olds 98 and the other from a pink 1959 Cadillac upholstered with cowhide. The reception desk is a 1947 Mercury coupe with a 1946 Ford grille and a surfboard for a roof.

“Every car I used was an unsalvageable pile of rust,” he said. “If you can build an office with paint and sheet rock (as he did) for the same cost as something mauve and boring it’s a no-brainer.”

Nearly every item in the office, which has 18-foot-high ceilings, has a personal connection for Myers. The reception area features a Big Boy sign because that was Myer’s favorite restaurant when he was a child. The patient exam room looks like where he used to order ice cream sundaes.

“It has a soda fountain facade. Named Fairmont's, it is the soda fountain my grandpa used to take me to,” Myers said.

The office is furnished with a movie theatre-style marquee where new patients have their names written in lights to welcome them to the office. Glass cases built into the walls are filled with Matchbox cars and other collections.

“There is a lot of stuff that is what my wife tells me I can put anywhere I want in the attic or garage,” Myers said.

Though he didn’t plan it, Myers said his unique office has been good for business. At his previous office in a non-descript strip mall his staff had to explain its location to callers. Now his free-standing building is a local landmark that people recognize.

“I didn’t have a presence,” he said. “Now we don’t have to describe where we are. Now people locate where they are by us.”

For any other dentists thinking of building a new office, Myers would advise using an architect. He spent a year searching the Internet before hiring one who specializes in dental office design.

“The best money you’ll spend is hiring a professional who knows what they’re doing,” he said. “I had the idea and knew what I wanted, but I didn’t know how to make it happen.”

He saved money by having plans firmly in place, and not having to ask for any costly changes once construction started.

What he learned from his previous office also contributed to creating a functional design. He knew, for instance, that he wanted to have separate spaces for his X-ray and records rooms. In his former office there was sometimes a wait for X-rays if a staff member was looking for records.

The look of joy that Myers sees on patients’ faces when they visit is worth it, he said. The office continues to be a work-in-progress.

“I still find stuff (for the office),” he said. “I was just hanging pictures yesterday.”

Hot rods accelerate orthodontist's practice

	America was still in the midst of the Great Depression when the Ottawa Dental Lab was founded in 1937 in Ottawa, Ill.  Having overcome tough economic times when the business began, the lab has had the confidence to fund a growth spurt despite the recent recession.

	The lab is operated by Luke Caruso, son of the founder Lucien “Tony” Caruso, along with his two sons, Luke III and Jim. They opened a Chicago office in 2010. The lab‘s second location was opened in 2007  in Lockport, Il.

	Luke Caruso, president/CEO, said having the Chicago facility enables members of the 110-person lab to connect with dentists in-person in the city more easily than it can from the home office in Ottawa, which is about 90 miles southwest of Chicago.

	“We felt in some ways we were a bit remote,” Luke Caruso said. “We felt it would allow us to take shades and to capture more opportunities. It’s important with new technology for dentists to have us come over. We’re more of a resource than we used to be.”

	Providing personalized service to the dentists who make up its customer base has always been part of the lab’s mission, even from its earliest days when the founder Tony Caruso’s philosophy was to treat every case as though it were for your mother.

	Fairly early on, Tony Caruso noticed that bread trucks would leave the town and travel many miles to deliver .50 cent loaves of bread. If bread was delivered that way, he figured the lab could foot the bill to deliver its products to customers, too.  Today the business has a fleet of 12 cars that travel about 2,500 miles a day.

	“Most labs don’t offer a personal delivery service. We do,” Luke Caruso said. 

	The lab has extended that mission of providing personal service, by putting lab staff in Chicago so they can be close at hand when a dentist performs a costly procedure and seeks their assistance. It is also part of a  long-term strategy the lab is pursuing to compete in all arenas of the marketplace.

	“We’re offering a wider variety of product mix at a wider price point,” Luke Caruso said.

	The lab has invested in new technology to provide less expensive products that will enable it to compete with products made off-shore. Jim Caruso, vice president of administration, estimates that off-shore products have increased from making up about 5 percent of the market five years ago to 25 percent.

	At the same time, the lab is going after the high-end customer through such initiatives as its Chicago office. Through investment in CAD/CAM technology, including  design software and milling capabilities, the lab has achieved its goal of offering a broad range of products and expertise.

	“We’re pretty progressive in adapting to new trends. We do a lot of analysis,” noted Luke Caruso III, vice president of new product development. “We can work with any implant system. We can do custom abutment design via CAD/CAM.”

	The lab has introduced 18 new products in the last year, said Jim.

	“Some labs don’t even have 18 products on their entire menu,” he said.

	Another part of the lab’s missions is to provide extensive training to its employees, most of whom come into the business without previous experience.

	“We have a full-time trainer on staff,” said Jim. “It allows us to mold our technicians and to have standardization in how our product is made.”

	Despite the new locations and wide range of new products offerings, the Carusos agree that their businesses is still is all about building a rapport and trust with its customers.

	"A lot of it still comes down to relationships,“ Jim said. "It’s about making every dentist feel they are important."

 America was still in the midst of the Great Depression when the Ottawa Dental Lab was founded in 1937 in Ottawa, Ill.  Having overcome tough economic times when the business began, the lab has had the confidence to fund a growth spurt despite the recent recession.

Legacy laboratories, Part II

	Anyone who’s wanted get in touch with their dentist in the middle of the night has probably experienced the frustration of connecting-not with a person who can empathize with the pain and provide help-but with a voice recording that can’t respond to a question or set up an appointment for first thing in the morning.

	Most dentists, too, know about the costs associated with having patients who miss appointments or the time lost and frustration of playing phone tag with them.

 is a mobile phone application that is providing a solution to some of these problems that have caused patients, along with their providers, to feel plenty of headaches-along with those throbbing toothaches-over the years.

	Patients can tap the application on an iPhone, Android smartphone or Blackberry to reach their dental office, no matter the time of day or their location.

	“It lets patients book appointments, request information on dental emergency, get post-operative care instructions. It also has GPS (directions) to the office,” said CEO Michael Stein, who began offering the product a year ago.

	A tap on the application allows users to choose from a menu of possible functions, such as setting up an appointment or getting first-aid instructions for a toothache.

	In the meantime, the patient also can use the application to point out on a touch screen graphic exactly which tooth is hurting, and a text message goes to the dentist to provide them with information about what the patient is experiencing, and even comments if the patient chooses to include them. 

	At the same time, the dental office can provide the patient with an appointment as soon as possible, and armed with information in advance, it allows the practice to more efficiently address the patient’s particular issue. It also can provide customized post-operative care instructions.

	Melissa Forness, marketing manager for Smudde Dental, a practice with about 6,000 patients in Valencia, Calif., said they started using the app in May. She said it makes them more efficient because they can better prepare to treat the patient before they  arrive at the office.

	“We can look back in the patient’s history to see if there has been any work on that particular tooth or if they had something that was diagnosed previously, but that they didn’t take care of,” she said. “We know better what we’re dealing with before they even come in.”

	When the office receives a message via the phone app about an after-hours dental emergency, Forness said they have their on-call staffer respond to the patient immediately by phone or text.

	Besides helping with emergency calls, the phone app also cuts down on missed appointments. The dental office can send reminders of appointments in advance. It can help a dentist build a practice by giving patients who use the app the ability to recommend their dentist to their friends, or if they are traveling out-of-town, to find a dentist who is recommended by their regular dentist.

	Forness said Smudde includes information about the phone app and how to download and use it in the goody bags that they hand out to patients. She said use of smartphones is so prevalent today that most of her office’s patients are accustomed to using apps and like the convenience of them.

	While the phone app was in development, Stein collected information on ways in which dentists need to become more efficient. A good source for this information was his father, Alan Stein, a dentist in Northridge, Calif.

	“He helped us perfect the product,” said Stein of his father’s contribution.

	Stein hopes the app, which a dentist must purchase and provide to their patients, will help dentists better run their practices and help patients who want to run their lives more efficiently.

	He believes patients who can get in touch with their dentists immediately are less likely to miss appointments or to let their dental care take a back seat to other things going on in their lives.

	“It allows them to act at the time of need rather than letting it fall by the wayside,” he said.

 Anyone who’s wanted get in touch with their dentist in the middle of the night has probably experienced the frustration of connecting-not with a person who can empathize with the pain and provide help-but with a voice recording that can’t respond to a question or set up an appointment for first thing in the morning.  Most dentists, too, know about the costs associated with having patients who miss appointments or the time lost and frustration of playing phone tag with them.

An app to empower patients

	Amos Harting, president of Harting Dental Arts Lab Inc. in St. Louis, bears more than just his father’s name. Like his predecessor, having artistic aptitude and mechanical skill have helped him thrive in the business.

	His father, also named Amos Harting, was fresh out of the armed services in the late 1940s when he was tapped to become a dental technician by his uncle, Weldon Niesling, who was a dentist who also operated a small dental lab.

	“My dad got out of the Navy and my uncle knew my dad was good with his hands and a good artist,” said Harting “That’s a paradox. It’s rare to have those skills together.”

	While today there are thousands of dental labs throughout the U.S., they were not as common in post-war America. It was not unusual for a dentist to fill the void by operating their own small labs.

	“There weren’t a lot of labs at that point,” said Amos Harting Jr. “A lot of dentist did their own gold work.”

	The elder Amos Harting worked for his uncle for about 10 years before launching his own lab in 1957 where he focused “on waxing, casting and gold crowns. That’s what they did back in the 1950s,” said Harting who joined the company in 1977.

	Being able to use those same skills-artistic ability and technical aptitude-are part of what Harting enjoys about the business. It’s also crucial to the success of any lab.

	“The big part in matching teeth is in the dental technicians skill, and in the materials and the knowledge of materials,” he said.

	Harting wasn’t planning on entering the business after college where he studied criminal justice. But his father asked him if he wanted to come aboard and he decided it would be a good move. He also went on to get an associate’s degree in dental technology.

	As company president, Harting has overseen the growth of the 10-person lab into new areas of expertise such as partials, dentures and hybrids. He estimates that about 75 percent of the business is generated from crowns and bridges and 25 percent is from removables.

	Hybrids are popular among people who want to replace their dentures and seek a better fit.

	“They’re more like natural teeth,” he said. “They don’t flop around in their mouths. Dentists like them because they’re removable and more repairable.”

	Focusing on hybrids “has made our business more diverse,” Harting added. “It also gives the dentist more options.”

	He said his company gets calls from other dental labs to do handle tough cases such as central incisors, which are hard to match.

	“It’s the hardest tooth in the mouth to do,” he said. “You can clearly see if the shade and shape don’t match. They (other labs) don’t want to do it because they can’t do it right and they have to do it over and over again.”

	As proof of its expertise Harting Dental Arts Lab provides continuing education classes for dentists.

	“We bring dentists in for educational seminars,” he said. “It adds value to our lab.”

	Harting also has worked with Vident, Nobel Biocare and other companies for many years teaching seminars on such topics as aesthetics, removable restorations and porcelain building to other technicians throughout the country.

	“The best part of teaching is that I have friends from all around the country because of it,” he said.

	A third generation in the family also has gotten into the business. Harting’s sons Blake and Barret handle porcelain where, once again, those seemingly opposing talents of artistic and mechanical skills come into play.

	Blake said he likes the job because “it’s open to your creative interpretation. You can really make something amazing and pretty. It’s fun to work with a paint brush and in the sculpting and building process.”

	Barret said he enjoys spending time on the bench with family.

	“It’s fun to work with family,” he said. “You can have a level of comfort that you don’t get with a boss you don’t know. You can talk about anything.”

	Harting said, "getting to work alongside his sons is just one more bonus of his job."

	“I love going to work on Monday because I love my job,” he said.

 Amos Harting, president of Harting Dental Arts Lab Inc. in St. Louis, bears more than just his father’s name. Like his predecessor, having artistic aptitude and mechanical skill have helped him thrive in the business.