Organizational Unity - New York State Dental Association

EDITORIAL 

Organizational Unity 

An important key to dentistry’s success. 

THE UNIQUE UNITY of the American Dental Association tripartite 

structure has contributed to the dental profession’s strong and 

influential presence in critical areas of health care. The New York 

State Dental Association’s record for planning for current and 

future oral health care needs is incontrovertible. PGY-1 (a mandatory 

accredited fifth year of postgraduate study for New York State 

licensure) and a modern and responsible perspective on the scope 

of practice of dental assistants represent forward thinking and 

proactive planning that can only benefit both the dental profession 

and the public it serves. 

Individual member support in the form of remaining knowledgeable 

about the real issues and challenges that face our profession, 

making dues payments and encouraging our national, state 

and local political lobbying efforts is important recognition of the 

responsibilities that accrue to membership in a professional organization. 

Members, in turn, expect that their leaders will represent 

them in the most responsible, professional and effective manner 

possible. And NYSDA does have an impressive track record for representing 

a diverse group of dentists. This is no easy task. Here, at 

The New York State Dental Journal, for example, it is a continual 

challenge to present relevant, interesting and informative articles 

that we hope will interest the clinician, academic, administrator 

and other members of the dental team. 

Unity is an important part of responsible leadership and member 

sensitivity. Dentists in Manhattan should be just as troubled 

about fluoridation issues elsewhere in the state (and country) as 

their upstate colleagues are about oral health access issues in the 

urban parts of New York State. Component districts have a responsibility 

to look beyond their geographical borders to focus on the 

“big picture” of what dentistry and the public want and need. Our 

NYSDA components, working together, remain an essential element 

in the Association’s success. 

The NYSDA Board of Governors meets twice a year to discuss, 

debate and vote upon resolutions that might affect the way you and 

I practice dentistry. Each component sends representatives 

(Governors) to these meetings. I am particularly impressed by the 

manner in which our Governors interact as they perform their 

duties on behalf of the entire NYSDA membership. They are serious 

about their responsibility. They are articulate and, even in the midst 

of legitimate and, at times, understandable disagreement, the presiding 

officers, staff and Governors are professional, collegial, 

respectful and fair. The deliberations that take place at these meetings 

culminate in sound and inclusive resolutions. 

Due to our organizational focus, we have been an important 

factor in keeping dentistry strong, vital and independent from outside 

forces that have agendas very different from those of the profession. 

Our record of keeping ADA member interests and the needs 

of the public in harmony is incontrovertible. 

This year, our very own Mark Feldman leads the ADA as president. 

William Calnon, NYSDA Trustee to the ADA, continues to 

share NYSDA’s progressive ideas with other leaders across the U.S. 

And NYSDA President Stephen Gold will chart yet another important 

year for the State Association. 

NYSDA owes its strength to a great membership and terrific 

leaders. We are fortunate to have both as we continue to meet the 

many challenges to our profession and professional organization. I 

am optimistic that we will continue to succeed in our effort to 

maintain our enviable position as a premier health profession with 

great value to the public and to individual dentists. 

As we begin 2008, your editorial team at The NYSDJ is ready to 

chronicle these exciting times. 

D.D.S. M.Sd 

4 NYSDJ • JANUARY 2008

On hand for presentation of ADA Golden Apple Award are, 

from left: 2007 President Steven Gounardes; ADA Trustee 

William Calnon; Reneida Reyes, Second District; Deborah 

Pasquale, chair, Council Membership and Communications, 

which oversees conduct of Children’s Dental Health Month 

observance. 

NYSDA Receives 

Apple for Day Without Sugar 

AT THE BOARD OF GOVERNORS Annual Meeting in 

November in Albany, NYSDA received the ADA 2007 

Golden Apple Award for Excellence in Dental Health 

Promotion to the Public. The national award, presented 

by ADA Second District Trustee William Calnon, 

recognized the NYSDA Sugarless Wednesday 

program, which takes place during the observance 

of Children’s Dental Health Month in February. 

NYSDA expanded its Sugarless Wednesday 

promotion last year and partnered with 

SchoolFood, the New York City Department of 

Education food service provider. The collaboration 

gave the Association access to more than 

500,000 children. 

To carry out the intent of the program, 

NYSDA created “kid-friendly” posters with information 

about sugars, the link between mouth and 

body health, and healthy nutrition tips. Free stickers 

with the messages “Take a Bite for Health” 

and “Snack Smart” were distributed the day of 

the event. Teachers across New York State 

received curriculum ideas and more than 22,000 

Sugarless Wednesday “Survivor” certificates for 

students who took part in the day’s events. 

Reneida Reyes, Children’s Dental Health 

Month Committee Chair for the Second District 

Dental Society, was instrumental in developing 

the program and in fostering NYSDA’s outreach 

to New York City schools. 

In making the presentation, Dr. Calnon 

noted that the Golden Apple was the second 

national award NYSDA received in 2007 for its 

children’s oral health efforts. Earlier in the year, 

NYSDA received the Samuel D. Harris Award, a 

$2,000 prize, for its overall CDHM programming. 

Photo by Mark Bauman, DDS 

NYSDA 

D i r e c t o r y 

OFFICERS 

Stephen B. Gold, President 

8 Medical Drive, Port Jefferson Station, NY 11776 

Michael R. Breault, President Elect 

1368 Union St., Schenectady, NY 12308 

Robert Doherty, Vice President 

280 Mamaroneck Ave., White Plains, NY 10605 

Richard Andolina, Secretary-Treasurer 

74 Main St., Hornell, NY 14843 

NY County-Lawrence Bailey 

215 W. 125th St., New York, NY 10027 

NY County-Matthew J. Neary 

501 Madison Ave., Fl. 22, New York, NY 10022 

NY County- Robert B. Raiber 

630 Fifth Ave., #1869, New York, NY 10111 

2-Michael L. Cali 

2003 E. 60th St., #1A, Brooklyn, NY 11234 

2-Craig S. Ratner 

1011 Richmond Rd., Staten Island, NY 10304-2413 

2-James J. Sconzo 

1666 Marine Parkway, Brooklyn, NY 11234 

3-Lawrence J. Busino 

2 Executive Park Dr., Albany, NY 12203 

3-John P. Essepian 

180 Old Loudon Rd., Latham,NY 12110 

4-Mark A. Bauman 

157 Lake Ave., Saratoga Springs, NY 12866 

4-James E. Galati 

Parkwood Plaza, 1758 Rte. 9, Clifton Park, 

NY 12065 

5-William H. Karp 

472 S. Salina St., #222, Syracuse, NY13202 

5-John J. Liang 

2813 Genessee St., Utica, NY 13501 

6-Robert G. Baker Jr. 

803-805 Cascadilla St., Ithaca, NY 14850 

6-Scott Farrell 

39 Leroy St., Binghamton, NY 13905 

7-Robert J. Buhite II 

1295 Portland Ave., Rochester, NY 14621 

Steven Gounardes, Immediate Past President 

351 87th St., Brooklyn, NY 11209 

Roy E. Lasky, Executive Director 

20 Corporate Woods Boulevard, Albany, NY 12211 

William R. Calnon, ADA Trustee 

3220 Chili Ave., Rochester, NY 14624 

BOARD OF GOVERNORS 

Annual Meetings 

Alan L. Mazer 

P.O. Box 985, 140 Terryville Rd. 

Pt. Jefferson Station, NY 11776 

Awards 

William R. Calnon 


Chemical Dependency 

Robert J. Herzog 

16 Parker Ave., Buffalo, NY 14214 

Dental Benefit Programs 

Ian M. Lerner 

One Hanson Pl., #2900 

Brooklyn, NY 11243-2907 

Dental Health Planning/ 

Hospital Dentistry 

Robert A. Seminara 

281 Benedict Rd., Staten Island, NY 10304 

Dental Practice 

Steven L. Essig 

33 Main St., Ravena, NY 12143 

Dental Education & Licensure 

Madeline S. Ginzburg 

2600 Netherland Ave., #117 

Riverdale, NY 10463 

Ethics 

Kevin A. Henner 

163 Half Hollow Rd., #1, Deer Park, NY 11729 

7-Andrew G. Vorrasi 

2005-A Lyell Ave., Rochester, NY 14606 

8- Jeffrey A. Baumler 

2145 Lancelot Dr., Niagara Falls, NY 14304 

8- Kevin J. Hanley 

959 Kenmore Ave., Buffalo, NY 14223-3160 

9-Edward Feinberg 

14 Harwood Ct., Ste. 322, Scarsdale, NY 10583 

9-Malcolm S. Graham 

170 Maple Ave., White Plains, NY 10601 

9- Neil R. Riesner 

111 Brook St., 3rd Floor, Scarsdale, NY 10583-5149 

N- Peter M. Blauzvern 

366 N. Broadway, Jericho, NY 11753-2032 

N-David J. Miller 

467 Newbridge Rd., E. Meadow, NY 11554 

N-Frank J. Palmaccio 

2 Bayard Drive, Dix Hills, NY 11746 

Q-Chad P. Gehani 

35-49 82nd St., Jackson Heights, NY 11372 

Q-Robert L. Shpuntoff 

28 Beverly Rd., Great Neck, NY 11021 

S-Paul R. Leary 

80 Maple Ave., #206, Smithtown, NY 11787 

S-Steven I. Snyder 

Suffolk Oral Surgery, 264 Union Ave., Holbrook, NY 11741 

B-Stephen B. Harrison 

1668 Williamsbridge Rd., Bronx, NY 10461 

B-Richard P. Herman 

20 Squadron Blvd., New City, NY 10956 

COUNCIL CHAIRPERSONS 

Governmental Affairs 

Alan L. Mazer 

P.O. Box 985, 140 Terryville Rd. 

Pt. Jefferson Station, NY 11776 

Insurance 

Roland C. Emmanuele 

4 Hinchcliffe Dr. 

Newburgh, NY 12550 

Membership & 

Communications 

Lidia Epel 

165 N. Village Ave. #102 

Rockville Center, NY 11570 

New Dentist 

David C. Bray 


Nominations 

Steven Gounardes 


Peer Review & 

Quality Assurance 

Steven Damelio 

1794 Penfield Rd. 

Penfield, NY 14526 

OFFICE 

Suite 602 

20 Corporate Woods Blvd. 

Albany, NY 12211 

(518) 465-0044 

(800) 255-2100 

Roy E. Lasky 

Executive Director 

Carla Hogan 

General Counsel 

Beth M. Wanek 

Associate Executive Director 

Michael J. Herrmann 

Assistant Executive Director 

Finance-Administration 

Judith L. Shub 

Assistant Executive Director 

Health Affairs 

Sandra DiNoto 

Director 

Public Relations 

Mary Grates Stoll 

Managing Editor 

Relief 

Anthony V. Maresca 

207 Hallock Rd. 

Stony Brook, NY 11790 NYSDJ • JUNE/JULY 2007 5 

NYSDJ • JANUARY 2008 5

Revisions to NYSDA Bylaws Proposed 

AT THE ANNUAL MEETING of the NYSDA Board of Governors in 

November, the following proposals were approved for presentation 

to the membership in accordance with NYSDA Bylaws Chapter XIV. 

The proposed amendments are printed here, in accordance 

with the NYSDA Bylaws. They will be presented to the members of 

NYSDA for their approval, with member voting to take place at designated 

meetings held in each component. The voting process must 

be completed by June 5, 2008. A NYSDA presentation and discussion 

of each proposal will be made at those meetings. 

I. Explanation of 101-2008 

The intent of this amendment is to increase the dues of full active 

members to $477 from the current rate of $407. 

Amendment 101-2008 (Resolution 8-N-07) 

Resolved : That Paragraph A of Section 10 of Chapter X of the 

NYSDA Bylaws be amended to read as follows (language in 

strikethrough is to be deleted; new language is underlined): 

CHAPTER X. FINANCES. 

Section 10. Membership Dues. 

A. Active Members. The dues for active membership of the 

Association shall be Four hundred seven ($407.00) seventy-seven 

($477) dollars per annum. Dues of active members are due January 

1 of each year. 

A majority vote of the voting members is required to approve 

101-2008 in order for it to be adopted. 

II. Explanation of 102-2008 

The intent of this amendment is to reorganize financial leadership 

positions to eliminate inconsistencies in the conduct of certain 

functions, strengthen the role of secretary-treasurer, and better 

comply with “good governance” initiatives. 

Amendment 102-2008 (Resolution 10-N-07) 

Resolved : That Section 100 of Chapter III of the NYSDA Bylaws be 

amended to read as follows (language in strikethrough is to be 

deleted; new language is underlined): 

Chapter III. Board of Governors. 

Section 100. Standing Committees of the Board of Governors. 

C. Finance, Budget and Audit 

1. Personnel. This committee shall consist of three (3) Governors, 

elected by the Board for a term of one (1) year and the 

Secretary-Treasurer. At least one such member shall have 

recent, relevant financial knowledge. The chairman shall be 

appointed by the President from the members of this committee 

for a period of one (1) year. 

2. Duties. 

a. To examine the books and records of the Association. 

b. To manage and to report on matters of investments to the 

Board of Governors. To select and contract with an independent 

audit firm to conduct an annual financial statement audit 

of the Association. Such audit firm, or its lead partner in 

charge of our engagement, must be changed at least every five 

(5) years. 

c. To study the audit of the Association’ accounts and to submit 

a certified audit of the financial condition of the 

Association for the fiscal year to the Board of Governors. 

d. To prepare a tentative budget for submission to the Board 

of Governors. 

And be it further 

RESOLVED: That Paragraph D of Section 90 of Chapter IV of 

the NYSDA Bylaws be amended to read as follows (language in 

strikethrough is to be deleted; new language is underlined): 


CHAPTER IV. ELECTIVE OFFICERS. 

Section 90. Duties of the Elective Officers. 

D. Secretary-Treasurer. It shall be the duty of the Secretary- 

Treasurer: 

1. To serve as an ex-officio member of the Board of Governors. 

2. To serve as an ex-officio member of the Board Committee on 

Finance, Budget and Audit. 

3. To record all proceedings of the meetings of the Board of 

Governors and the Association. 

4. To serve as the elected officer responsible for the administrative 

and financial functioning of the Association. 

5. To serve as custodian of all monies, securities and deeds 

belonging to the Association. He/she shall hold and invest 

same subject to the rules and regulations prescribed by the 

Board of Governors. 

6. To review and approve all invoices and disbursements. 

7. To make disbursements when the Executive Director is not 

available, upon the order of the Board of Governors or upon 

presentation of a voucher, in duplicate signed by the President 

or the President Elect. 

8. To be the responsible person for the employment of the auditor 

and to submit a certified audit of the financial condition of 

the Association for the fiscal year to the Board of Governors. 

9. To furnish an adequate bond at the expense of the Association. 

10. To make an accounting of dues and assessments as provided in 

Chapter IX of the Bylaws. 

11. To perform such other duties as may be assigned by the 

President or the Board of Governors. 

12. To, notwithstanding any other provision of the Constitution 

and Bylaws, in consultation with legal counsel, make all necessary 

technical editorial changes to the Constitution and Bylaws 

relating to spelling, grammar, punctuation, renumbering or 

relettering, name changes, gender neutrality, or other similar 

technical editorial matters. All such changes shall be reported 

by the Secretary-Treasurer to the Board of Governors at the 

Board of Governors meeting immediately following the making 

of such changes. Nothing in this provision shall be construed 

as allowing the Secretary-Treasurer to make any substantive 

change to the Constitution or Bylaws. Pursuant to 

Article VIII of the Constitution and Chapter XIV of the Bylaws, 

any change made by the Secretary-Treasurer may be altered or 

rescinded. 

The Secretary-Treasurer shall be responsible for: 

1. The recording of all proceedings of the meetings of the Board 

of Governors and the Association. 

2. The secure custody of all monies, securities and deeds belonging 

to the Association.He/she shall ensure such funds are 

invested in accordance with the rules and policies prescribed 

by the Board of Governors, and will report periodically on the 

investment performance of such assets. 

3. The selection of investment advisory companies for managing 

excess Association funds, subject to the approval of the 

Executive Committee. 

4. A proper and periodic accounting of all financial transactions 

to the Board of Governors. 

5. The development of an annual operating budget for the 

Association for approval bythe Board of Governors. Such budget 

must be developed in consultation with the President, 

President Elect, Vice President, and Executive Director. 

6. Securing an adequate bond at the expense of the Association 

for pertinent members and employees serving on official 

Association business. 

7. All necessary technical editorial changes to the Constitution 

and Bylaws relating to spelling, grammar, punctuation, renumbering 

or relettering, name changes, gender neutrality, or other 

similar technical editorial matters. All such changes shall be 

reported by the Secretary-Treasurer to the Board of Governors 

at the Board of Governors meeting immediately following the 

making of such changes. Nothing in this provision shall be 

construed as allowing the Secretary-Treasurer to make any 

substantive change to the Constitution or Bylaws. Pursuant to 

Article VIII of the Constitution and Chapter XIV of the Bylaws, 

any change made by the Secretary-Treasurer may be altered or 

rescinded. 

8. Any other duties as may be assigned by the President or the 

Board of Governors. 

and be it further 

RESOLVED: That appropriate editorial changes be made at 

other appropriate places in these Bylaws where the affected entities 

are mentioned. 

A two-thirds vote of the voting members is required to approve 

102-2008 in order for it to be adopted. 

D. Secretary-Treasurer. The Secretary-Treasurer shall serve as an 

ex-officio member of the Board of Governors and in other positions 

as defined in these Bylaws. He/she shall serve as the elected officer 

responsible for the administrative and financial functioning of the 

Association and shall utilize the Executive Director, as appropriate, 

to fulfill such. 


Annual Meeting 2007 

Congratulations and well wishes were frequently 

heard at Board of Governors Annual Meeting 

November 15 in Albany as NYSDA installed 

its new officers and shone the spotlight on 

recipients of Association’s top honors. 

Newly installed officers for 2008 are, from left, Vice President Robert Doherty, 

President Elect Michael Breault, President Stephen Gold, Immediate Past 

President Steven Gounardes, Secretary-Treasurer Richard Andolina. 

Photos by by Tim Bill Raab,Northern Cancellare Photo Jr. Services 

Board members Steven Snyder, left, Suffolk County, and Lawrence Busino, 

Third District. 

2007 Hallmarks of Excellence Award went to Queens County Dental Society. 

Accepting award on behalf of QCDS are, from left, Joseph Caruso, Chad 

Gehani, Robert Shpuntoff. Presenter is Deborah Pasquale, chair, Council 

Membership and Communications. 

EDPAC Chair Lawrence Volland and Vice Chair Robert Raiber with New York 

County Dental Association representatives. Pictured from left are Melvyn 

Leifert, Governor Matthew Neary, Dr. Volland, Dr. Raiber, NYSDJ Editor Elliott 

Moskowitz, Governor Lawrence Bailey. 

2007 President Steven Gounardes, left, receives ADA President’s Plaque 

from ADA President Mark Feldman. 


is night to remember 

NYSDA Past President Michael Fallon Jr., recipient of 2007 Distinguished 

Service Award, was accompanied to meeting by family. Pictured from left are 

Michael Fallon, Patty VanBrunt, Kathy Byrne, Dr. Fallon, Colleen Arnold, Genine 

Fallon, Mark Fallon, Tom Fallon, Patrick Fallon. 

ADA President Mark Feldman with Robert Raiber and Lidia Epel, who like 

Dr. Feldman, hail from Nassau County. 

Peter Theodorou, New York County, winner, New Dentist Leadership Award, is 

congratulated by Lawrence Bailey. Looking on are Elliott Moskowitz and 

Melvyn Leifert. 

Bronx County colleagues are, from left, Governor Richard Herman, Council 

Education Chair Madeline Ginzburg, Executive Director Robert Yeshion, 2007 

President Robert Margolin, Amarillis Jacobo, Governor Stephen Harrison. 

Incoming Governor Scott Farrell, left, gets together with Sixth District colleagues 

whose terms on NYSDA Board concluded at Annual Meeting. They are 

2006 President Alfonso Perna, center, and Robert Giannuzzi. 


Annual Meeting 2007 is night to remember 

ADA Trustee Bill Calnon, left, with 2007 Seventh District President Neal Levitt. 

Hail, hail, the gang’s all here from Suffolk County. From left: Frank Palmaccio; 

Stephanie Demas, ASDA representative from Stony Brook University; Jeffrey 

Seiver; Steven Snyder; newly installed NYSDA President Stephen Gold; Paul 

Leary; David Miller; Kevin Henner; Robert Peskin. 

Among those being honored for completing terms on NYSDA Board are 

David Kraushaar, left, governor from Ninth District, and John Asaro, who 

stepped down as secretary-treasurer. 

Michael Fallon Jr., recipient of NYSDA Distinguished Service Award, with 2007 

President Steven Gounardes and ADA President Mark Feldman. 

18 NYSDJ • JANUARY 2008 

Fred Wetzel, far left, who completed term as governor from Fourth District, 

with wife, Shannon, and Susan and Mark Bauman, also from Fourth District.

B O A R D O F 

President 

Stephen B. Gold 

President Elect 

Michael Breault 

Vice President 

Robert Doherty 

8 Medical Dr., Port Jefferson Station, NY 11776 

DDS, NYU College of Dentistry, 1974. 

Residency, Brookdale Hospital,1976. 

Board Certification, Pediatric Dentistry, 1979. 

Director, Dept. Dentistry, St. Charles Hospital; 

Attending Staff, Mather Hospital; Attending 

Staff/Medical Board, St. Charles Hospital; 

Assistant Clinical Professor, Dept. Children’s 

Dentistry, Stony Brook University. 

Pediatrics, Port Jefferson Station. 

NYSDA: Executive Committee. 

ADA: Delegate. 

Suffolk County Dental Society: Past President; 

Member, Executive Board, Board of Delegates. 

Other: Diplomate, American Board Pediatric 

Dentistry. 

1368 Union St., Schenectady, NY 12308 

DDS, Georgetown University, 1977. 

Certificate Periodontics, Fairleigh Dickenson 

University, 1979. Certificate Training 

in TMD, University of Medicine & Dentistry, 

New Jersey, 1984. 

Certificate Training in Implantology, 

Harvard University 

School of Dental Medicine, 1989. 

Staff, General Practice Residency, 

St. Clare’s Hospital, Schenectady. 

Periodontics/Surgical Placement of 

Implants, Schenectady. 

NYSDA: Executive Committee. Member, NYSDJ 

Editorial Review Board. 


Fourth District Dental Society: Past President; 

Associate Editor, District Newsletter. 

280 Mamaroneck Ave., White Plains, NY 10605 


BA, NYU College of Arts and Sciences, 1963. 

Residency, Oral and Maxillofacial Surgery 

Bellevue/NYU/ Manhattan VA Hospitals, 

1969-1972. Senior Attending Oral and 

Maxillofacial Surgeon, White Plains 

Hospital Center. 

Oral and Maxillofacial Practice, White Plains, NY. 

NYSDA: Executive Committee. Recipient, 

NYSDA Distinguished Service Award, 2006. 

ADA: Leadership Conference, Action Team Leader. 

Ninth District Dental Association: Past 

President; Recipient, D. Austin Sniffen Medal of 

Honor. 

Other: Fellow, American Association Oral and 

Maxillofacial Surgeons, New York State Socety 

Oral & Maxillofacial Surgeons. 

Secretary-Treasurer 

Richard F. Andolina 

Immediate Past 

President 

Steven Gounardes 

74 Main St., Hornell, NY 14843 

BA, Ohio State University, 1975. 

DDS, University at Buffalo School of Dental 

Medicine, 1980. Millard Fillmore Hospital, Buffalo, 1981. 

General Practice, Hornell, NY. 

NYSDA: Executive Committee. Member, Finance, 

Budget & Audit Committee. 

EDPAC: Secretary, Component Chair. 


Seventh District Dental Society: Treasurer; 

Past President; Chairman, Budget & Finance 

Committee; Member, Executive Director 

Coordinating Committee; Member, Nominating 

Committee; Member, District Malpractice 

Claims Committee; Member, Program 

Planning Committee; Member, Strategic 

Planning Committee. 

Other: Past President, Steuben County Dental 

Society; Recipient, Humanitarian of the Year- 

University at Buffalo School of Dental Medicine, 

2004; George B. Greenwood Award, Seventh 

District Dental Society. 


BA, Brooklyn College, 1976. 


General Practice Residency, Woodhull Hospital, 

1986. Fellowship, Woodhull Hospital, 1987. 

Attending, Kingsbrook Jewish Medical Center, 

Brooklyn; Assistant Director, Department 

Dentistry & Oral Maxillofacial Surgery, Woodhull 

Medical Center, Brooklyn. 

General Practice, Brooklyn. 



Second District Dental Society: Past President. 

Other: Member, Hellenic Dental Society, Bay 

Ridge Dental Society, Organization Committee 

Greater New York Dental Meeting. 


2 0 0 8

G O V E R N O R S 

Members By District 

New York County 

Lawrence Bailey 


Matthew J. Neary 


Robert B. Raiber 

43 West 61st Street, Apt. 15-F, New York, NY 10023 

DDS, Howard University, 1982. MPH, Health 

Administration, Columbia University, 1986. 

Residency, Harlem Hospital Center/Sydenham 

Neighborhood Family Care Center. Clinical Assistant 

Attending, Columbia University College of Dental 

Medicine; Advisory Committee Member, Hostos 

University; Clinical Researcher, PEARL Network 

Practitioner Advisory Group, New York University. 

Director, Department Dentistry/Associate Medical 

Director/Attending Dentist, Renaissance Health 

Care Network. 

General Practice, NYC. 


New York County Dental Society: Committee 

Chairman, Greater New York Dental Meeting; 

Past President. 

Other: Manuscript Review and Evaluation, 

American Association Public Health Dentistry. 

501 Madison Ave., New York, NY 10111 

DDS, Columbia University College of Dental 

Medicine, 1980. Certificate Periodontics, 

Columbia University College of Dental 

Medicine, 1982. Adjunct Assistant Professor 

Dentistry, Columbia University; Facilitator, Ethics 

Program, Columbia University; Tour Commander, 

NYC Office of Chief Medical Examiner. 

Periodontics, New York, NY. 

NYSDA: Member, Council on Nominations. 

New York County Dental Society: Past 

President. 

Other: Past President, New York Society Forensic 

Dentistry; Past President, Columbia Periodontal 

Alumni Association. 

630 Fifth Ave., #1869, Rockefeller Center, 

New York, NY 10111 

DDS, NYU College of Dentistry, 1972. Residency, Navy 

Dental Corps, 1974. Adjunct Assistant Professor, Columbia 

University; Ethics Facilitator, Columbia University. 

General Practice, NYC. 

NYSDA: Executive Committee; Vice Chairman, NYS Dental 

Foundation; Chairman, Finance, Budget & Audit; Vice 

Chairman, EDPAC. 

ADA: Delegate; Vice Chairman, Council on Government 

Affairs. 

New York County Dental Society: Past President; Member 

at Large,Executive Committee; Chair,New York County EDPAC. 

Other: Vice Chairman, NYC Chapter American College 

of Dentists; Humanitarian Award, New York Academy 

Dentistry for WTC Forensics; Recognition Certificate, 

Office of Chief Medical Examiner, NYC; Certificate of 

Recognition for volunteer service, Hooper Bay, Alaska. 

Second District 

Michael L. Cali 


Craig S. Ratner 


James J. Sconzo 

2003 E. 60th St., Ste.1A, Brooklyn, NY 11234 

BS, Brooklyn College of CUNY, 1981. 


Bellevue Hospital Center, NYC Health and 

Hospitals Corp.; 

NYU Medical Center, Chief Resident Dentistry, 

Dept. Oral & Maxillofacial Surgery, 1986; 

NYU College of Dentistry, Clinical Instructor, 

Dept. Oral Medicine and Pathology, 1990. 



ADA: Political Action Committee,Action Team Leader. 

Second District Dental Society: Past President; 

Member, Board of Trustees. 

Other: Chairman, Township Ethics Board, 

Marlboro, NJ. 

1011 Richmond Rd., Staten Island, NY 10304 

BS, Union College, 1988. 

DMD, New Jersey Dental School, 1992. 

General Practice Residency/Chief Resident, 

Staten Island University Hospital. 

Clinical Attending, Staten Island University Hospital. 

General Practice, Staten Island. 

ADA: Alternate Delegate. 

Second District Dental Society: President; Co- 

Editor, SDDS Bulletin. 

Other: Past President, Richmond County Dental 

Society. 

1666 Marine Parkway, Brooklyn, NY 11234 

BS, Upsala College, 1977. 

DMD, Tufts University, 1981. 

General Practice Residency, Kings County 

Hospital, 1982. Attending, New York Methodist 

Hospital; Chief Dental Implantology, New York 

Methodist Hospital. 


Second District Dental Society: Past President; 

Member, Oral Health Committee; Member, Peer 

Review Committee; Member, Board of Trustees. 

N Y S D A 


B O A R D O F 

Third District 

Lawrence J. Busino 

Third District 

John P. Essepian 

Fourth District 

Mark A. Bauman 

2 Executive Park Dr., Albany, NY 12203 

DDS, Columbia University, 1977. Residency, 

Oral & Maxillofacial Surgery, Mt. Sinai,1980. 

Attending, Albany Medical Center, St. Peter’s 

Hospital; Chief, OMS Dept., Memorial Hospital. 

Oral & Maxillofacial Practice, Albany. 


Third District Dental Society: Past President; 

Member, Committee for Dental Health and Health 

Planning. 

Other: Past President, NYSSOMS; Diplomate, 

American Board Oral & Maxillofacial Surgery; 

Member, American College Dentists and 

American Academy Cosmetic Surgeons, 

Member/Delegate, Committee on Governmental 

Affairs, AAOMS. 

180 Old Loudon Rd., Latham, NY 12110 

BA, Houghton College, 1955. 

DDS, McGill University, 1959. 

Graduate School, University of Michigan, 1960. 

Chairman Dentistry, Memorial Hospital, Albany. 

General Practice, Latham. 

NYSDA: Component Chair, EDPAC. 

Third District Dental Society: Treasurer; 

Member, Planning Committee, Executive 

Committee, Insurance Committee. 

Other: Chairman, American College Dentists, 

Hudson-Mohawk Chapter; Member, International 

College Dentists; Fellow, Academy General 

Dentistry, International College Dentists, 

American College Dentists; New York State 

Senate Liberty Award, 2004. 

157 Lake Ave., Saratoga Springs, NY 12866 

BS, Union College, 1969. 

DDS, New York University, 1974. 

General Practice Residency, David Grant Medical 

Center, Travis Air Force Base, 1975. 

Staff Dentist, Castle Air Force Base, 1977. 

General Practice, Saratoga Springs. 

NYSDA: Member, Council on Membership & 

Communications, Council on Nominations, 

Constitution & Bylaws Committee. 

ADA: Delegate; Member, Tripartite Grassroots 

Initiative. 

Fourth District Dental Society: Past President. 

Other: Past President, Saratoga County Dental 

Society; Fellow, American College Dentists, Vice 

President Mohawk-Hudson Section; Fellow, Pierre 

Fauchard Academy. 

Fourth District 

James E. Galati 

Fifth District 

William H. Karp 

Fifth District 

John J. Liang 

1758 Parkwood Plaza, Clifton Park, NY 12065 

DDS, Georgetown University School of 

Dentistry, 1988. BS, University of Maryland. 

General Practice Residency, Albany Medical 

Center Hospital, 1989. 

General Practice, Clifton Park. 

NYSDA: Member, Council on Dental Practice. 


Fourth District Dental Society: Past President. 

8179 Cazenovia Rd., Manlius, NY 13104 

B.S., Union College, 1976. DDS, New York 

University, 1982. Residency, Strong Memorial 

Hospital, University of Rochester School of 

Medicine and Dentistry, 1983. 

Attending, St. Joseph’s Hospital. 

General Practice, Manlius. 


ADA: Delegate 

Fifth District Dental Society: Past President. 

Other: Past President, Onondaga County Dental 

Society. 

2813 Genesee St., Utica, NY 13501 

DMD, University of Pittsburgh, 1980. 

MS, University of Pittsburgh, 1976. 

BS, University of Pittsburgh, 1973; 

Attending, SUNY Canton Dental Hygiene 

Program and VA Hospital, Griffis Technology 

Park, Rome, NY. 

General Practice, Utica. 



Fifth District Dental Society: Past President. 


2 0 0 8


Sixth District 

Robert W. Baker Jr. 

Sixth District 

Scott J. Farrell 

Seventh District 

Andrew G. Vorrasi 

412 N. Tioga Street, Ithaca, NY 14850 

BS, Colgate University. DMD, University 

Pennsylvania School of Dental Medicine, 1985; 

Certificate Orthodontics, University Rochester, 

Eastman Dental Center, 1987. Clinical Instructor 

University of Rochester, Eastman Dental Center; 

Consulting Orthodontist, Curacao, Netherlands 

Antilles; Visiting Professor, University Ferrara, 

Department Orthodontics, Ferrara, Italy. 

Orthodontics, Ithaca. 


Sixth District Dental Society: Chairman, 

Council on Dental Practice. 

Other: Past President, Cortland County Dental 

Society, Cayuga County 

Dental Society, Tompkins Co. Dental Society. 


B.S. Biology, Villanova University, 1984. 

DDS, Cum Laude, Medical College Virginia 

School of Dentistry, 1988. Supervising Dentist, 

Broome Community College, School Dental 

Hygiene. 

General Practice, Binghamton. 

NYSDA: Executive Committee. Member, Council 

on Nominations. 


Sixth District Dental Society: Member, 

Executive Committee. 

2005 Lyell Ave., Rochester, NY 14606 

BS, St. John Fisher College, 1974. 

MA, University at Buffalo, 1976. 


Medicine, 1980. 

General Practice, Rochester. 


Seventh District Dental Society: Past President; 

President, SDDS Dental Administrators. 

Seventh District 

Robert J. Buhite II 

Eighth District 

Jeffrey A. Baumler 

Eighth District 

Kevin J. Hanley 

1295 Portland Ave.,Rochester, NY 14621 




2145 Lancelot Dr., Niagara Falls, NY 14304 

BS, Magna cum Laude, Niagara University, 1974. 

MS, Magna cum Laude, Niagara University, 

1975. DDS, University at Buffalo. Misch 

Implant Institute 

1992. Army Dental Corps, 1984. 

General Practice, Niagara Falls. 


Eighth District Dental Society: Past President; 

Building Committee Chair 

Other: Fellow, American College Dentists; 

Member, International Congress Oral 

Implantologists, American College Oral 

Implantology and American Society 

Osseointegration. 

959 Kenmore Ave., Buffalo, NY 14223-3160 

BA, University at Buffalo, 1974. DDS, University 

at Buffalo, 1978. Certificate in Orthodontics, 

University of Connecticut, 1980. Orthodontic 

Residency, University of Connecticut, 1980. 

Orthodontic Practice, Buffalo. 

NYSDA: Executive Committee. Associate Editor, 

New York State Dental Journal; Editor, NYSDA 

News. Member, Council on Nominations. 


Eighth District Dental Society: Past President; 

Member, Eighth District Orthodontic Academy. 

Other: Past President, UB Dental Alumni 

Association; Member, American College Dentists 

and International College Dentists. 

N Y S D A 


B O A R D O F 

Ninth District 

Edward Feinberg 


Malcolm S. Graham 


Neil R. Riesner 

14 Harwood Court, Suite 322, Scardsdale, NY 

10583 

DMD, Tufts University, 1977. 

Internship, Bronx Lebanon Hospital. 

Private Practice, Scarsdale. 

ADA: Grassroots Action Team Leader; 

Grassroots Team Coordinator, Subcommittee on 

Recruitment and Retention. 

Ninth District Dental Association: Past 

President; Centennial Committee Chairman. 

Other: Past President, Scarsdale Dental Society; 

Director, Westchester Academy Restorative 

Dentistry; Member, Exhibit Committee, Greater 

New York Dental Meeting. 

170 Maple Ave., White Plains, NY 10601 

BS, Colby College, 1961. DDS, Columbia 

University College Dental Medicine, 1965. 

General Practice Residency, Beth Israel 

Medical Center, 1966. 

Clinical Instructor, New York Weill Cornell 

Medical Center; Assistant Attending Dentist, 

New York Weill Cornell Medical Center. 

General Practice, White Plains. 


Ninth District Dental Society: Past President. 

Other: Past President, White Plains Dental 

Forum; Chairman, New York Section, American 

College Dentists. 

111 Brook St., 3rd Floor, Scarsdale, NY 10583-5149 

DDS, University Pennsylvania, 1955. 

Certificate Orthodontics, University of Pennsylvania, 1959. 

Navy Dental Corps, 1955. 

Scientist in Resident, Lehman College, City 

University of New York. 

Orthodontics Practice, Scarsdale. 

NYSDA: Member, Council on Insurance; Chairperson, 

Professional Liability Claims Committee. 


Ninth District Dental Society: Past President; 

Vice Chairman, Insurance Committee; 

Chairman, Malpractice Claims Committee; 

Chairman, Practice Transfer Committee. 

Other: Chief Forensic Odontology, Office Chief 

Medical Examiner Westchester County; Member, 

Metropolitan Forensic Anthropology Team. 

Nassau County 

Peter M. Blauzvern 

Nassau County 

David J. Miller 

366 North Broadway, Jericho, NY 11753 

DDS, New York University, 1983. 

Clinical Instructor, Dept. Dental Medicine, Long 

Island Jewish North Shore Hospital. 

General Practice, Jericho. 

NYSDA: Member, Council on Dental Practice. 


Nassau County Dental Society: Past President; 

Member, Board of Directors, Peer Review Board, 

District Claims Board; Business Manager, Dental 

Journal; Chairman, Council Dental Practice, 

Children’s Dental Health. 

Other: Director, Greater Long Island 

Dental Society. 

467 Newbridge Rd., East Meadow, NY 11554 

BS, St. John’s University, 1980. DDS, 

Georgetown University, 1984. 

General Practice Residency, Woodhull Hospital, 

1985. Assistant Professor 

Clinical Dentistry, New York Medical College. 

Assistant Clinical Professor, 

Columbia University College Dental Medicine. 

Director, General Practice 

Residency Programs, Caritas Medical Center, 

Mary Immaculate 

Hospital. Member, Board of Trustees, St. 

Francis & Mercy Medical Centers. 

Member, Board of Trustees, Health Systems, 

Catholic Charities, Diocese of 

Rockville Center. Delegate to Medical Board, 

Caritas Medical Center. 

General Practice, East Meadow. 

NYSDA: Executive Committee; Member, Council 

on Dental Health Planning; Recipient, Bernard P. 

Tillis Award, 2000. 

ADA: Delegate; Member, Council on Access, 

Prevention, Interprofessional Relations. 


Member, Executive Committee, Board of 

Directors, Committee Dental Health Planning & 

Hospital Dentistry, Budget & Finance; 

Publications Coordinator, Give Kids A Smile. 

Other: Advisory Committee, Greater Long Island 

Dental Meeting; Member, NYS Dept. of Health 

Medical Record Access Review Committee; 

Advisory Committee; New York Society for 

Forensic Dentistry. 


2 0 0 8


Nassau County 

Frank J. Palmaccio 

Queens County 

Chad P. Gehani 

Queens County 

Robert L. Shpuntoff 

2 Bayard Drive, Dix Hills, NY 11746 

DDS, Columbia University College Dental 


Residency, Temple University School of Dental 

Medicine and Booth Memorial Medical Center. 

Periodontics Practice, Woodbury; Sachem 

Dental Group, Holbrook, NY. 

ADA: Delegate 


Chair, Insurance Committee and Nomination 

Committee. 

Other: Member, Long Island Academy 

Periodontics; Fellow, Long Island Academy 

Periodontics; American Academy Periodontology. 

35-40 82nd St., Jackson Heights, NY 11372 

BDS, University Bombay, 1973. Postgraduate, 

Endodontics, Columbia University College 

Dental Medicine, 1981. General Practice 

Residency, Beekman Downtown Hospital, 1978. 

Associate Clinical Professor Endodontics, NYU 

College of Dentistry. Chair, Department 

Endodontics, Flushing Hospital Medical Center. 

Endodontics Practice, Jackson Heights. 

NYSDA: Executive Committee; Member at 

Large, EDPAC; Director, NYS Dental Foundation. 

ADA: Delegate; Member, Council on 

Membership, Committee on International 

Programs & Development. 

Queens County Dental Society: Past President; 

Member, Board of Trustees. 

Other: Past President, Indian Dental 

Association. 

28 Beverly Rd., Great Neck, NY 11021 

BS, SUNY Stony Brook, 1976. MS, New York 

University, 1979. 

DMD, Tufts University, 1982. Certificate, Fellow in Oral 

Implantology, Brookdale Hospital Medical Center, 

1983. 

Certificate Orthodontics, New York University 

College Dentistry, 1990. 

Orthodontics Practice, Littleneck. 

Queens County Dental Society: Past President; 

Member,Board ofTrustees,Continuing Education 

Committee; Pre-meeting Committee Organizer; 

Member, National Children’s Dental Health Month 

Committee. 

Other: Member, American Association 

Orthodontics, Northeast Society Orthodontists, 

Alpha Omega International Dental Fraternity. 

Suffolk County 

Paul R. Leary 

Suffolk County 

Steven I. Snyder 

Bronx County 

Stephen B. Harrison 

80 Maple Ave., #206, Smithtown, NY 11787 

BS, St. Joseph’s University, 1982. DDS, Temple 

University, 1986. 

General Practice, Smithtown. 

Suffolk County Dental Society: Past President; 

Chairman, Council on Education. 

Other: Member, Academy General Dentistry. 

264 Union Ave., Holbrook, NY 11741 

BS, SUNY Binghamton, 1977. DDS, New York 

University College Dentistry, 1981. 

General Practice Residency, Brookdale Hospital 

Medical Center, 1983. Hahnemann University 

Hospital, Oral & Maxillofacial Surgery, 1987. 

Assistant Clinical Professor, Stony Brook School 

of Dental Medicine. Affiliated, St. Catherines of 

Siena, Smithtown. 

OMFS Practice in Holbrook, Smithtown, Stony 

Brook, Brentwood. 

NYSDA: Member, Council on Insurance. 


Suffolk County Dental Society: Past President. 

1668 Williamsbridge Rd., Bronx, NY 10461 

BA, Adelphi College, 1961. Graduate work, 

University Missouri, 1962. DDS, New York 

University, 1966. General Practice Residency, 

Bronx Lebanon Hospital, 1967. 

General Practice, Bronx. 

NYSDA: Member, Council on Nominations, 

NYSDA-MLMIC Underwriting/ Claims Review 

Committee. 

Bronx County Dental Society: Member, Peer 

Review Committee; Member, Executive Board; 

Chairman, District Claims Committee. 

Other: Fellow, Pierre Fauchard Academy, 

National College Dentistry. 

N Y S D A 


B O A R D O F G O V E R N O R S 

Bronx County 

Richard P. Herman 

ADA Trustee 

William R. Calnon 

20 Squadron Blvd., New City, NY 10956 

BS, City College of New York, 1970. DDS, 

Columbia University College Dental Medicine, 1974. 

General Practice, Bronx and New City. 


ADA: Member, ADA Code Revision Committee, 

Third Party Subcommittee, Subcommittee on the 

Code, Code Workshop Work Group, Claim Form 

Work Group. 


BS, SUNY College of Environmental Science 

and Forestry, Syracuse University, 1974. DDS, 

University Buffalo, 1978. General Practice 

Residency, University of Rochester, Strong 

Memorial Hospital, 1979. 


NYSDA: Past President. 

Seventh District Dental Society: Past 

President; Member, Council on Awards. 

Other: Vice Regent, International College 

Dentists; Fellow, American College Dentists, 

Pierre Fauchard Academy; Member, NYS 

Department of Health Diabetes Education Task 

Force; Advisory Committee Member, Monroe 

Community College Department of Dental 

Studies. 


2 0 0 8 N Y S D A

Nominees Sought for NYSDA Honors 

THE NYSDA COUNCIL ON AWARDS is seeking nominees for the 

Association’s two merit awards—the William Jarvie and Harvey J. 

Burkhart Award and the Distinguished Service Award. 

The council will consider nominees according to its criteria 

and guidelines for selecting award recipients. These guidelines are 

printed here. The council expects to make its selection on April 7, 

although it reserves the right to withhold either of the awards if it 

feels no nominee meets the criteria. 

The 2008 Jarvie-Burkhart Award will be presented in October at 

the New York State Dental Foundation Awards Luncheon in New York 

City. The Distinguished Service Award will be given out in November 

at the NYSDA Annual Meeting. Nomination forms appear on the following 

page. Nominations must be submitted no later than March 7. 

Awards Criteria and Guidelines 

The William Jarvie and Harvey J. Burkhart Award 

The Jarvie-Burkhart Award is presented in recognition of great service 

rendered mankind in the field of dentistry. It is the highest 

honor bestowed by the New York State Dental Association. 

Nominees must have accomplished advancement in at least 

one of the following areas: 

• Promotion of continuing dental education 

• Advancement of dental research 

• Philanthropic endeavors in the field of dentistry 

• Original contributions to the science and application 

of dentistry 

Nominees may be an individual dentist or nondentist or 

an organization. 

The application must list complete and detailed pertinent 

information as to the accomplishments in the field of dentistry 

and include corroborative endorsements and testimony from as 

many sources as possible evidencing great service resulting from 

these accomplishments. 

The Jarvie-Burkhart Award is presented at the Annual 

Board of Governors Meeting of the New York State Dental 

Association. It is the highest award that NYSDA can bestow and 

must not be seen as synonymous with the Distinguished 

Service Award, which was established to recognize an individual’s 

contributions to organized dentistry. Therefore, it is not 

necessarily given every year. The Council on Awards shall only 

recommend presentation of the Jarvie-Burkhart Award if the 

council is of the opinion that the above criteria/guidelines have 

been met. The recommendation shall then be forwarded to the 

Board for its approval. 

The Distinguished Service Award 

This award is presented to an individual in recognition of numerous 

years of service and commitment to the New York State Dental 

Association. The following criteria should be considered and 

weighed in making the determination: 

• Contributions to NYSDA 

• Contributions to organized dentistry as a whole 

• Offices and positions held 

• Length of the individual’s service 

The council will review the nominations at its April meeting. 

At that point, if the council believes that an individual is worthy of 

the award, the council may nominate the individual. The nomination 

must state the specific reasons for choosing the individual and 

specify how the individual has met the criteria in its report to the 

Board. If the council finds that no one meets the criteria, the award 

will not be given for that year. 


NOMINATION FORM FOR THE WILLIAM JARVIE & HARVEY BURKHART AWARD 

Name of Nominee: 

Submitted by: 

The Jarvie-Burkhart Award is presented in recognition of great service rendered mankind 

in the field of dentistry. It is the highest honor bestowed by the New York State Dental Association. 

Nominees must have accomplished advancement in at least one of the following areas: 

• Promotion of continuing dental education 

• Advancement of dental research 

• Philanthropic endeavors in the field of dentistry 

• Original contributions to the science and application of dentistry 

Nominees may be an individual dentist or nondentist or an organization 

Please specify how the nominee has accomplished advancement in the areas noted above: 

Please fill in circle if continued on attached pages 

Please list any other reasons you believe the nominee is deserving of this award: 


Please attach Curriculum Vitae or other appropriate documents detailing the background and general information regarding the nominee. 

NOMINATION FORM FOR THE DISTINGUISHED SERVICE AWARD 

Name of Nominee: 

Submitted by: 

The Distinguished Service Award is presented to an individual in recognition of numerous 

years of service and commitment to the New York State Dental Association. The following 

criteria will be considered and weighed in making the determination: 

• Contributions to NYSDA 

• Contributions to organized dentistry as a whole 

• Offices and positions held 

• Length of individual’s service 

Please specify how the nominee has contributed to NYSDA, organized dentistry as a whole 

and include the offices and positions held and length of service: 


Please list any other reasons you believe the nominee is deserving of this award: 


Please attach Curriculum Vitae or other appropriate documents detailing the background and general information regarding the nominee. 


Photos by Lynn Spinnato, E. Setauket, NY. 

NYSDA President Stephen Gold 

monitors work of GPR residents at 

St. Charles Hospital Dental Facility, 

Port Jefferson. They are, from left, 

Jaime Seidman, Jared Percyz, 

Brian Davis. 

2008 NYSDA President Stephen B. Gold 

Caring, Compassionate and a Need to Serve 

NYSDA’s top elected official’s approach to life and his profession is formed by his own personal struggles. 

Robert Benton, D.D.S. 

STEVE GOLD has been a dear friend and colleague for almost 30 

years. In that time, we have worked together closely at all three levels 

of organized dentistry—local, state and national. So, when he 

asked me to write this article, I accepted with great enthusiasm and 

humility. Steve is, indeed, a very special person. 

Steve was born in Brooklyn to parents, Ruth and Louis. He 

inherited positive characteristics from both of them that he still 

adheres today and which have helped mold his life and his personality. 

His dad was a successful accountant with a strong sense of 

value. Steve remembers that his dad was a patient listener and in 

times of dispute would always consider where both parties were 

coming from before rendering a decision. He was very charitable, 

a man of his word, and he treated everyone honestly and with 

loyalty. 

His mom was an elegant and artistic woman, extremely meticulous 

up to the last years of her life, when her health was failing. Her 

sense of aesthetics was instilled in Steve’s psyche, and this influenced 

him both in his daily life and his dental practice. 

Steve’s brother, Jeffrey, is also a dentist, with a general practice 

in New City. As an older brother, he was a role model for Steve, and 

they have always been very close. Steve admits that Jeffrey dominated 

him in athletics, but he remembers the exultation that came 

with finally beating him in tennis. 

Career Formed by Childhood Accident 

Steve was raised in Brooklyn and attended Lincoln High School, 

where, as a senior, he was vice president of the student government. 

He graduated from Brooklyn College and then moved on to dental 

school, attending New York University College of Dentistry, from 

which he graduated in 1974. 

When I asked Steve why he chose dentistry as a career, he 

recalled an incident from his childhood that has remained a vivid 

memory to this day.“In 1958,” he related,“when I was 9, I fell off my 

bike and landed smack on my face. My two central incisors fractured. 

An inverted “V” marked the space where the mesial aspects of my 

incisors were missing. I remember the horrified look on my mother’s 

face when she saw my bloodied mouth and broken teeth. They 

remained that way for many years, and during that time, I never 

smiled for any photograph, I was so self conscious. They were eventually 

crowned when I was 17.Maybe that was one of the reasons why 

I became a pediatric dentist. Maybe that is why I feel no child should 

be ashamed of his or her smile. Maybe that is why I believe no individual 

should ever be allowed to suffer from dental discomfort.” 

At NYU, Steve was the editor of the school newspaper for two 

years. During both high school and college, he volunteered to work 

with children with special needs, which he found extremely gratifying. 

This also prompted him to choose pediatric dentistry as a specialty. 

He spent two years at Brookdale Hospital in Brooklyn to fulfill 


his pediatric residency, and in 1979, he 

received board certification in his specialty. 

Once in practice, his greatest fulfillment 

came from helping apprehensive and 

handicapped children overcome their 

fears. Steve emphasizes that his own private 

battles with cancer over the past 20 

years have made him more sensitive to 

these fears and have caused him to treat 

these children with greater understanding 

and compassion. 

No Wives Allowed 

Steve met his wife, Ruth Kalish, in his second 

year at Brooklyn College. They were 

married in 1972. Life was a bit of a financial 

struggle at the time, while Steve completed dental school and his 

residency. He remembers they lived in a “cold water flat”in Brooklyn 

after their marriage, and that the couple “kept each other warm.” 

Ruth took a $90-a-week job as bookkeeper in a local car dealership 

to keep them afloat. 

In 1976, they moved to Suffolk County on Long Island, where 

Steve opened his first pediatric practice, in Port Jefferson Station. 

He laughs when he remembers his “no wives in the practice” policy. 

He originally intended to join with a fellow resident as a partner, 

but Steve vehemently refused when he was told his friend wanted to 

bring his wife with him. 

Ironically, shortly after opening the practice, Steve’s receptionist 

called in sick.Ruth came to the rescue,but,again,Steve emphasized that 

it was only “temporary.”However, it did not take long for Steve to recognize 

Ruth’s great management skills. She stayed on, became a tremendous 

asset to the practice and 30 years later still holds the office together, 

helping to direct a staff of 

over 35 part- and full-time 

employees. 

The Golds have lived in 

their Setauket, Long Island, 

home since 1978. They have 

two daughters, Melissa and 

Wendy, ages 25 and 24, who 

are their pride and joy. They 

admit that they probably 

spoiled them, but they are 

proud of their accomplishments. 

Melissa graduated 

from Skidmore College in 

Gold family at home. From left, Wendy, Steve, Melissa, Ruth. Steve and Ruth have been married 35 years. 

Steve's growing pediatric dental practice now consists of 2 offices and over 35 employees. 

With Steve at center of photo are partners Robert Serino, to his right, and Philip Coniglio, to 

his left. Immediately next to Steve is wife, Ruth, who manages practice. 

Saratoga Springs in 2004 

and is a successful event 

producer at Empire Entertainment 

Inc. in Manhattan. Wendy is a graduate of Quinnipiac 

University in Hamden, CT, and holds a Masters Degree in occupational 

therapy. She is on the staff of “Just Kids” in Lindenhurst, on 

Long Island. 

Both girls share their parents’ passion for tennis. They all 

played together often as the girls were growing up. Consequently, 

Melissa and Wendy became accomplished players, just like their 

mom and dad, and Wendy is a part-time tennis instructor. 

Steve’s other sports addiction is golf. He would be the first to 

admit that he struggles a bit with the game, but he loves being out 

on the links and sneaks away whenever he can. 

Meritorious Service 

As Steve’s practice continued to grow, in 1986, he selected Robert 

Serino as a partner. Another partner, Philip Coniglio, joined the team 

in 2005. In 2004, they added a second office in Wading River. At present, 

in addition to Dr. Gold, 

Dr. Serino and Dr. Coniglio, 

the team consists of three 

pediatric dentists and two 

orthodontists. 

Steve has a long history 

of active participation in 

organized dentistry. When 

he was 36, he became the 

youngest person to be elected 

president of the Suffolk 

County Dental Society. We 

all were concerned at the 

time that his youthful good 

looks and “laid back” demeanor 

would negate his 

ability to gain the respect of 


the older members. Boy, did he prove us wrong! 

He has served on both the Board of Delegates 

and Executive Board since Suffolk County 

became a component in 1981. He also served as 

chairman of the Dental Health and Health 

Planning Committee. In 2000, Suffolk County 

presented him with its highest honor, the Robert 

Raskin Award for Meritorious Service. 

At the state level, Steve was chairman of 

NYSDA’s observance of Children’s Dental Health 

Month and chair of the Council on Dental Health 

Planning and Hospital Dentistry. He was a member 

of the Finance, Budget & Audit Committee. 

He was appointed to the Board of Governors and 

served from 1991 to 1998. And he has been a 

member of the Executive Committee since 2006. 

Steve was a delegate to the American Dental 

Association from Suffolk County from 1988 to 

1996 and again in 2006 and 2007. In 1989, he 

received the ADA Access Award for development 

of the “Directory of Dentists and Dental Clinics 

for the Disabled in Suffolk County.” 

Steve has been extremely active in education, 

both at the university and hospital levels. In 1977, he was 

appointed clinical assistant professor at the School of Dental 


At St. Charles Hospital, Port Jefferson, where he heads Dental Department, Steve has nurtured and grown 

general practice dental residency program. Close associate is Fran Barrett, dental clinic supervisor, pictured 

at his right in GPR residents and staff photo. 

Medicine at Stony Brook University, where he is well known for 

his devotion and enthusiasm for pediatric dentistry and patient 

management. Steve is currently excited about teaching postgraduate 

students enrolled in Stony Brook’s new pediatric dental residency 

program. 

Since 1976, he has been on the staffs of both Mather and St. 

Charles hospitals in Port Jefferson. In 1999, he was appointed chief 

of the Dental Department at St. Charles and has sat on the Medical 

Board since then. Giving time on behalf of his local community 

hospitals has become one of his passions. He is especially proud of 

the general practice dental residency program at St. Charles. Over 

50 volunteer dentists staff this program, teaching and providing 

dentistry for the underserved in the Port Jefferson area. 

In 1995, Steve received the “Teddy Roosevelt Award,” which is 

the highest honor St. Charles Hospital awards a staff member. It 

commemorates many years of outstanding service to the hospital 

and the community. 

A Wise Choice 

Steve has never allowed his ongoing battle with cancer to stand in the 

way of the values he holds dear. His positive and upbeat attitude and 

joie de vivre set an example for all who have known him. His family 

has always been his number-one priority.His devotion to them, to his 

parents and in laws, to his patients and staff, to his friends and colleagues, 

and to dentistry in general is a well-known fact. 

The New York State Dental Association is indeed fortunate to 

have Steve Gold at its helm in 2008. Our Association is in 

extremely capable hands. Steve will do an outstanding job. You 

can bet on it!

At work in his Suffolk pediatric dental office, Steve treats Alex Pietrowsky. Alex's mother, Kristen, 

is in foreground. Dental assistant Susan Navarro is at right. 

The Children Need Us 

PRESIDENT STEPHEN GOLD describes his goals for his presidential 

year. In a word, from recruiting new members to caring for 

children, he believes New York State’s dentists need to do more. 

The NYSDJ: Membership recruitment and retention remain 

critical to the future of our dental organizations. Do you have any 

thoughts on how to make organized dentistry more relevant to 

practicing dentists, especially new practitioners, to attract them 

to our associations and keep them there? 

Dr. Gold: ADA President Mark Feldman has stated, “When it 

comes time for renewing ADA membership each year, I want 

every member to renew with confidence, based on a clear 

understanding of value received.” 

We must constantly remind our members and emphasize to 

new practitioners how organized dentistry works for them. We 

must endeavor to demonstrate how our legislative, political, educational 

and public service components enhance and safeguard 

our profession and the public that we serve. 

How do we accomplish this? We can do so with increased 

communication. Expanded use of the Internet, along with print 

and broadcast media, is the way to get the message out. 

I believe, however, that the best way to attract new members 

is by using a personal one-on-one approach. Current dental leaders 

and members must seek out our new colleagues and make 

them personally feel welcome. Younger dentists must be shown 

that they are part of a greater dental community and that they are 

not alone. Remind them that they are part of an esteemed profession. 

The dental profession can only remain great if it continues 

to be protected by our united, hardworking tripartite structure. 

Recent graduates are faced with great unknowns: How to 

repay the cost of their dental education? How to establish or 

enter an existing dental practice? 

How will governmental interventions affect their livelihood? They 

must be made to believe that NYSDA and the ADA are there to 

help them face their future. 

When I graduated in 1974, there were two females in my 

class of 180. There were few minorities. The demographics on 

dental students have changed, and that is good. Special emphasis 

must be made to attract our younger, more diversified dentist 

population. Only by doing so can our profession remain viable. 

The NYSDJ: It seems we spend a lot of time talking about 

access to care. What specific steps can the dental profession 

take to ensure that people now outside of the delivery system are 

reached? 

Dr. Gold: Access to care remains a vital concern for certain 

segments of our society. This is especially true for the special 

needs patient. In 2006, the Center for Disease Control issued a 

report that forecast that autism spectrum disorders would be 

diagnosed in 1 out of 150 children. That to me is an epidemic. 

There are not enough pediatric dentists and/or hospitalbased 

programs to cover this patient population. Over time, 

these children will become adults, and that will bring a whole 

new set of concerns. 

I propose that NYSDA, together with the New York State Dental 

Foundation work to develop and implement programs to educate 

general dentists on how to care for special needs patients. 

I have been told that the average GP has no heart, that 

he/she does not care and will not be interested in this type of 

training. I do not believe that. Autism cuts through all socio-economic 

lines; there are no cultural safe havens. We must be willing 

to try to provide basic dental care to this patient population. 

If we do not, we may, indeed, be talking about our own loved 

ones who will be unable to obtain dental services in the future. 


In Steve Gold's ideal world, every 

youngster would be a smiling dental 

patient. 

I look for the members of NYSDA to actively help in this endeavor. 

When these educational programs are in place, I urge dentists 

throughout the state to avail themselves of them—not just for 

my sake, but for the sake of the children of New York State. 

The NYSDJ: What legislative initiatives will help bring care 

to this patient population? 

Dr. Gold: Some special needs patients present challenges 

that require dental treatment be rendered in an operating room 

under general anesthesia. The medical costs for hospitalization 

and general anesthesia can be quite high. Most medical insurance 

companies in New York State will not reimburse for these 

expenses. Nearly half of the states in our country have passed 

legislation mandating medical insurance coverage for young 

children with special needs who need dental care rendered in 

a hospital/operating room setting. New York State must pass 

similar legislation as soon as possible. Not to do so would be 

an injustice. 

The NYSDJ: As a pediatric dentist, you are, of course, particularly 

interested in bettering the care young patients receive. 

What deficits do you see now in delivering care to youngsters, 

and how do we eliminate these shortcomings? 

Dr. Gold: My father took me to the dentist for the first time 

when I was about 5 or 6 years old. His office was at One Hanson 

Place in Brooklyn. On the way to my first visit, my dad advised 

me, “Dr. Shiplikoff hates kids. He is only seeing you today as a 

favor to me.” Dr. Shiplikoff was my dentist for the next 15 years. 

He was a lovely and caring individual. He did not “hate” children 

at all. Rather, as he confided to me years later, he was actually 

“scared” of treating young children. 

According to the CDC, the prevalence of cavities in the baby 

teeth of children ages 2 to 5 increased to 28 percent in 1999- 

2004, from 24 percent in 1988-1994. Last year, New York State 

adopted legislation that urges that all entering elementary school 

children obtain dental notes. In order for these children to be 

seen, more dentists need to feel comfortable treating them. 

Indeed, the ADA recommends that all children have a “dental 

home” and be seen by a dentist by age 1. Additional training 

must be offered so general dentists can partake in these initiatives. 

I am proud to say that the New York State Dental 

Foundation is partnering with the NYU College of Dentistry to 

develop programs to educate dentists on treating young children. 

When these programs are offered in 2008, I urge as many 

New York State dentists as possible to enroll in them. 

The NYSDJ: With the specter of universal health care and 

possible governmental intervention in access issues what should 

NYSDA’s goals be in New York State? 

Dr. Gold: As an organization we must fulfill our dual mission 

statement of serving the dental profession and the public of New 

York State. If we do not lead and propose solutions to the issues 

we know, others will. The only way to properly serve our membership 

and the public is to be in the forefront. We must be the ones 

advocating innovative ideas and models of dental care delivery. 

As we start 2008, our goals as an organization must include: 

1. Working with all appropriate agencies and organizations 

to develop solutions that enable New Yorkers to receive proper 

oral health care. 

2. Working to ensure that any substantive changes that are proposed 

in the oral health care delivery system truly benefit the populace 

and maintain the dentist as the captain of the dental team. 

3. Enabling our dental colleagues, our NYSDA members, to 

not only understand the rationale for any changes but to embrace 

them. ■ 


Bisphosphonate-associated Osteonecrosis 

A Clinician’s Reference to Patient Management 

Varinder S. Grewal, BsC., D.D.S.; Edgar P. Fayans, D.D.S. 

Abstract 

Bisphosphonates, as inhibitors of osteoclasts, are widely 

used in the management of metastatic bone disease and 

in the prevention of osteomalacia and osteoporosis. 

Recent cases of bone necrosis of the jaws have been 

associated with the use of bisphosphonate therapy. A 

case is presented of a patient with osteonecrosis of the 

maxilla with a history of long-term bisphosphonate therapy 

for metastatic breast cancer. The authors treated the 

patient and suggest appropriate patient management 

guidelines with reference to current knowledge. 

Although a definitive treatment for bisphosphonateassociated 

osteonecrosis has not yet been established, 

clinicians must be aware of the pharmacologic properties 

of several bisphosphonates currently available and their 

indications, susceptible risk factors in the development of 

osteonecrosis of the jaws, the clinical signs and symptoms, 

and recommendations for patient management, 

including prevention and early recognition. 

BISPHOSPHONATES (BPs), potent inhibitors of osteoclast-mediated 

bone resorption, were first introduced over 20 years ago. Since 

then, they have been used widely in the management of bone diseases, 

including hypercalcemia related to malignancy, myelomarelated 

bone disease, Paget’s disease and osteoporosis. 1,2 They have 

also been shown to inhibit tumor cell proliferation and inhibit 

angiogenesis. 1,3 These additional features have made BPs useful in 

the treatment of metastatic disease, including breast and prostate 

cancer, resulting in a rise in the medical use of these drugs. 1 

However, recent reports suggest that BPs, particularly the 

nitrogen-containing BPs pamidronate (Aredia) and zoledronic acid 

(Zometa), both manufactured by Novartis of East Hanover, NJ, are 

capable of causing bisphosphonate-associated osteonecrosis of the 

jaw (BON). 1 With 2.5 million patients treated with pamidronate 

and/or zoledronate worldwide, BON occurs in about 1 per 10,000 

treated patients (Novartis, unpublished data, 2004). 4 

Currently, the total number of reported cases associated with alendronate 

(Fosamax, Merck and Co., Inc., Whitehouse Station, NJ) the 

most commonly prescribed oral bisphosphonate, is approximately 170 

worldwide (C. Arsver, oral communication, March 2006). 5 This corresponds 

to a spontaneous BON incidence of approximately 0.7 cases per 

100,000-years exposure. 5 However, there is insufficient data to determine 

why the osteonecrosis reported seems to particularly affect the 

jaw, with a slightly higher rate in the mandible than the maxilla. 1 

This report concerns the management of a patient with BON. 

Information provided includes: the pharmacologic properties of 


the several bisphosphonates currently available; the pathobiological 

mechanism; the clinical presentation of the oral lesions; and 

recommendations for the oral management of patients who have 

received BP therapy, with consideration of a preventative approach 

based on current knowledge. 

Case Report 

An 85-year-old woman presented to the Department of Dental 

and Oral Surgery at Brookdale University Hospital and Medical 

Center, Brooklyn, NY, with painful, exposed bone in the buccal 

portion of the left maxilla of unknown duration. It was presumed 

to be secondary to occlusal trauma by masticatory forces from 

unopposed mandibular teeth. Her past medical history included 

metastatic breast cancer (treated by a right mastectomy), ulcerative 

colitis, glaucoma, anemia, hypertension and renal impairment. 

Her history of medications included pamidronate—which 

had been discontinued prior to the initial visit as recommended 

by her oncologist—arimidex, megace, xalatan and cosopt, procrit 

and diovan. The dosage of pamidronate was 90 mg every four 

weeks (intravenously over a two- to four-hour period) for approximately 

30 months. 

Also at the time of initial consultation, the patient was not 

wearing any denture prosthesis and had not developed any other 

extraoral areas of exposed bone necrosis. The patient reported no 

history of tobacco or alcohol use. Traumatic insult from the 

supererupted opposing tooth, #22, appeared to be a contributing 

factor. No other traumatic risk factors, such as dental extractions, 

correlated to the etiology of the lesion were noted. 

At the time of presentation, the patient complained of ongoing 

discomfort and pain in the maxillary region and was edentulous in 

the maxilla, with only teeth #22 and #27 present. Both of these teeth 

were extracted because of a poor prognosis following a one-week regimen 

of amoxicillin 500 mg. Upon examination, bone exposure of the 

maxillary alveolus was found in the left quadrant about 2.5 cm x 6 cm 

in size (Figures 1a, b). There was no bleeding upon probing the nonpainful, 

exposed, devitalized bone, which appeared yellow-brown in 

color with an irregular, rough surface texture. The surrounding soft 

tissues were erythematous and edematous (Figure 2). These findings 

are consistent with osteomyelitis related to avascular necrosis. 

Computed tomography of the head without contrast revealed 

bone destruction with perforation of the inferior segment of the 

left maxillary sinus, along with bilateral chronic maxillary sinusitis 

(Figure 3). The ethmoid, sphenoid and frontal sinuses were found 

to be clear with no fluid levels. Bone specimens collected during the 

initial visit indicated fragments of squamous ephithelium and 

numerous bacteria, including E coli and peptostreptococcus sp., 

organisms commonly involved in osteomyelitis. The specimens 

also showed foci of scalloping margins and interosseous aggregates 

of neutrophils consistent with the diagnosis of osteomyelitis. 

Treatment 

As the first course of treatment, systemic antibiotic therapy was 

prescribed for three months to control secondary infection. 

Figure 1a. Impression model of patient with osteonecrosis in upper left quadrant 

of palate and history of having received bisphosphonate therapy. 

Figure 1b. Close-up image of impression model of osteonecrotic site. 

Figure 2. Intraoral examination revealed extensive necrosis of alveolar bone and 

infection of surrounding tissue. 


Figure 3. Coronal CT demonstrating bone destruction of maxillary alveolus with 

perforation of inferior segment of maxillary sinus and evidence of bilateral chronic 

maxillary sinusitis. 

Figure 4a. Necrotic alveolar bone and surrounding tissue during surgical 

debridement. 

Figure 4b. Surgical site following necrotic debridement. 

Levaquin 500 mg qd and flagyl 500 mg bid PO were selected because 

of their excellent bioavailabilty, tissue penetration and combined 

spectrum of activity, including streptococcus species—the most 

prominent causative bacteria in osteomyelitis of the maxilla—E 

coli and other gram-negative pathogens and anaerobes. The patient 

was then treated with surgical debridement, followed by curettage 

of the residual necrotic bone under local anesthesia (Figures 4a, b). 

The objective of the maxillary sequestrectomy was to establish vital 

bone margins to initiate healing. 

Prior to the procedure, a 1 gm vial of parenteral vancomycin 

500 mg was administered slowly to prevent SBE. Following debridement 

of the necrotic bone and removal of granulation tissue, the 

surgical site was approximated with non-absorbable sutures and 

allowed to heal by secondary intention (Figures 4c, d). The initial 

debridement of sequestrum was completed using minimal anesthesia 

in order to explore where neural stimulus was appreciated within 

the edges of bleeding bone. Finally, an antiseptic mouthrinse 

(chlorhexidine 0.12%) and wound irrigation with 50:50 hydrogen 

peroxide were provided as palliative treatment for the osteomyelitis 

and as a preventative measure for fungal overgrowth. 

During the course of treatment, new lesions of non-vascularization 

and bone exposure were detected in the mandible on the 

sites of teeth #22 and #27 five months following their extractions. 

This is consistent with documentation that extractions of teeth may 

be a precipitating event in BON. 

Discussion 

Bisphosphonates are synthetic analogues of pyrophosphate characterized 

by a phosphorus-carbon-phosphorus structure essential for 

the affinity to bone and two side chains attached to the carbon 

atom: the first chain (R¹) controls the affinity to hydroxyapatite 

crystals in bone (as determined by an –OH group); the second 

chain (R²) determines the potency of the BPs (as determined by the 

presence of an amino group). 6 For example, pamidronate, an amino 

bisphosphonate, is approximately 100-fold more potent than 

etidronate, a non-amino bisphosphonate, in vivo. 6 

The relative potencies of BPs is related to their inhibitory 

effects on bone resorption. 6 As Table 1 illustrates, with properties of 

some currently available BPs, the greater the potencies, the lower 

the dosage required to achieve the same effect. 7 Since high doses of 

bisphosphonates may impair normal remodeling and mineralization 

of the bone, BPs with more potent antiresorptive activity that 

allow a greater range of safety for normal mineralization are considered 

most valuable for treatment. 

The clinical presentation of BON may include pain, soft tissue 

swelling and infection, loosening of teeth, drainage and exposed 

bone. 5 Marks and Stern (2003) were the first to conclude that 

patients with multiple myeloma who receive pamidronate may 

develop avascular necrosis of the jaw bones. 8 Ruggiero et al. (2004) 

reported 63 additional cases of ONJ over a three-year span (2001- 

2003, inclusive). 9 They also believe that patients who have been 

using potent BPs for more than six months are at highest risk for 

developing this condition. 9 


More recently, an Internet-based survey that evaluated the 

incidence of BON concluded the mean time to the onset of this condition 

was 18 months and 6 years for patients receiving zoldronic 

acid and pamidronate therapy, respectively. 10 Age, particularly over 

65 years, may also be a contributing risk factor. 5 In addition, the 

risk for developing BON is much higher for cancer patients on IV 

bisphosphonate therapy than those on oral therapy. This may be 

because less than 1% of the oral dose of BP is absorbed by the gastrointestinal 

tract, whereas 50% of the IV dose is bio-available for 

incorporation into the bone matrix. 5 

Although the antiresorbing potency of BPs varies substantially, 

BPs are classified by their similarity in absorption, distribution 

and elimination via renal excretion, as they have currently shown 

no evidence of metabolism. Thus, they share the ability to bind in 

bone for a prolonged period, for up to 10 years in human bone, 

depending mainly on the bone turnover rate. 6,11 Therefore, the 

potential for BP-associated osteonecrosis to develop may remain 

for years despite discontinued use of the drug. This may also 

explain why efforts at revascularization with hyperbaric oxygen 

therapy may be considered futile. 12,13 Unlike osteoradionecrosis, 

which is characterized by hypoxia and hypovascularity, the pathological 

factor in BP-associated osteonecrosis involves an imbalance 

in bone metabolism and bone mass homeostasis. 1 

The action of BPs is related to their effect upon osteoclasts as 

part of a bone remodeling cycle. During bone resorption, osteoclasts 

resorb the mineral matrix of bone and release bone morphogenic 

proteins (BMP) and insulin-like growth factors intended 

to stimulate osteoclasts and form new bone, thereby maintaining 

bone mass homeostasis. 14 However, when BPs are incorporated into 

the hydroxyapatite structure of bone during bone resorption, they 

are subsequently released to inhibit the resorption activity of osteoclasts. 

As a result, the bone remodeling cycle is disrupted so that 

dead osteocytes are not replaced, thus leading to osteonercrosis. 14 

Although the mechanism of action of BP-associated osteonecrosis 

is not yet clear, one currently recognized mechanism is the 

apoptotic pathway seen particularly with the non-nitrogen containing 

BPs, for example, etidronate. As the osteoclasts degrade the BPcoated 

bone, the two outer phosphate groups of cellular ATP are 

replaced by the dual phosphate groups of the BPs, thereby creating a 

toxic form of ATP, eventually causing programmed cell death. 15 

Another mechanism in the case of nitrogen-containing BPs, 

pamidronate, for example, involves their action on the mevalonate 

pathway (cholesterol biosynthesis from mevalonic acid). It is 

believed that bisphosphonates block farnesyl diphosphate synthase 

(FPP synthase), an enzyme involved in this pathway (Figure 5). This 

results in limitations on the critical intermediates of this pathway, 

which inactivates the osteoclastic cells. 11,15 As a result, a decrease in 

the rate of formation of components in the bone remodeling unit 

results in an avascular area leading to bone necrosis. 

There are several reasons why the oral cavity in particular may 

be susceptible to this condition. The oral cavity is a site for host 

bacterial interactions that may contribute to osteomyelitis; bones of 

the jaw constantly undergo mechanical loads in which a remodel- 

Figure 4c. Postsurgical site after debridement of necrotic tissue to viable bone 

margins. Surgical site was packed with iodoform gauze. 

Figure 4d. Surgical site at three-month follow-up evaluation. 

ing response may not facilitate the imbalance of this process associated 

with BPs; patients with cancer being treated with BPs in 

addition to chemotherapy may experience a synergistic effect 

toward bone cell death by disruption of the bone remodeling 

process and alteration of the intraosseous vascularity; 8 extraction 

sockets may not heal adequately from disruption of bone cell activity 

and bone formation; and, finally, since BPs are distributed to 

bone via the bloodstream, the rich vascular supply of the maxilla 

may also contribute to this condition, as in the case of our patient. 1 

One common side effect of BPs is kidney dysfunction. All BPs 

are potential toxins for the kidneys. Toxic and/or more frequent 

doses of pamidronate may cause an excess of a serum protein 

called albumins in the urine (nephrotic syndrome). 2 Toxic doses of 

zoledronate may cause an increase in serum creatinine, an indication 

of kidney dysfunction. To minimize the potential for kidneyrelated 

problems for patients treated with BP therapy, Table 2 presents 

a list of recommendations that should be followed by doctors. 

2 At our patient’s initial visit, her creatinine level was 2.6 mg/dl 


TABLE 1 

Pharmacologic Properties of Bisphosphonates 

DRUGS RELATIVE INDICATIONS MECHANISM DOSAGE ONSET OF DURATION ELIMINATION 

POTENCY OF ACTION FORMS ACTION HALF-LIFE 

Didronel® 1 Paget’s disease Inhibits bone resorption Tablets: IV:24hrs Can persist for 1-6 hrs 

(Etidronate) Hypercalcemia via actions on 200mg, PO:1-3 12 months w/out 

Heterotopic osteoclasts; mineral 400mg months con’t therapy 

ossification release and collagen IV: 50mg 

Osteoporosis ◆ 

breakdown in bone 


prophylaxis 

Skelid® 10 Paget’s disease Inhibition of normal Tablet: Several 6 days 150 hrs 

(Tiludronate#) and abnormal bone 200mg weeks 

resorption via osteoclasts 

Aredia® 100 Paget’s disease Inhibits bone resorption Aredia: Powder 24-48 hrs Hypercalcemia 21-35 hrs 

(Pamidronate§) Hypercalcemia via actions on for injection 2-7 days 

Osteolytic metastases osteoclasts 30mg&60mg Paget’s disease 

Osteoporosis ◆ Pamidronate: 1 month 

Hyperthyroidism ◆ 

Solution for 

Osteogenesis 

injection 3mg, 

imperfecta ◆ 

6mg,9mg 

Powder for 

injection 

30mg&90mg 

Fosamax® 100-1000 Osteoporosis in Inhibits bone Tablet: 5mg, 1 month Entire treatment 10 yrs 

(Alendronate†) women & men resorption via 10mg,35mg, of Fosamax 

Paget’s disease actions on 40mg,70mg 

Steroid-induced osteoclasts; Solution: 

osteoporosis in men & decrease rate 70mg/75mg 

women, Hypercalcemia ◆ 

of bone resorption 

Actonel® 1000-10,000 Osteoporosis Same as Fosamax Tablet: 5mg, 14 days Stable for up Initial 1.5 hrs 

(Risedronate‡) treatment & 30mg,35mg to 3 yrs Terminal 480 hrs 

prophylaxis 

Paget’s disease 

Osteolytic metastases ◆ 

Boniva® 1000-10,000 Osteoporosis Inhibits bone resorption Tablet: 2.5mg, 1-3 month Stable for up 37-157 hrs 

(Ibandronate Osteoporosis via osteoclasts; 150mg to 3 yrs 

††) prophylaxis decrease rate of I.V: 3mg 

Paget’s ◆ disease bone resorption 

Hypercalcemia ◆ 

Osteolytic ◆ metastases 

Zometa® >10,000 Hypercalcemia Inhibits bone resorption, Solution for 7 days Median Initial 

(Zoledronic Multiple myeloma calcium release, injection 32 days 0.24-1.87 hrs 

acid¥) Osteolytic metastases osteoclastic activity 4mg/5ml Terminal 


146 hrs 

prophylaxis 

Paget’s disease 

◆ 

Non-FDA-approved indication 

REFERENCE: 

* Lacy C et al. 17 

** Facts and Comparison online [database online]. 18 

† Fosamax® [package insert]. Whitehouse station, NJ: MERCK& CO. Inc. 2005 

‡ Actonel® [package insert]. Cincinnati, OH: P&G Pharmaceuticals. 2006 

§ Aredia® [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation. 2005 

Didronel® [package insert]. Cincinnati, OH: P&G Pharmaceuticals.2005 

# Skelid® [package insert]. New York, NY: Sanofi Pharmaceuticals. Inc.2002 

¥ Zometa® [package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation. 2005 

†† Boniva® [package insert]. Nutley, NJ: Roche, Inc. 2005 


(reference range: 0.8-1.7 mg/dl), which may have been a side effect 

of the BP in addition to advanced age. 

A recent study by Dunford et al. (2001) 16 described the method 

used to determine that farnesyl diphosphate (FPP) synthase is the 

major pharmacologic target of bisphosphonates in vivo and also that 

small changes to the structure of the R² side chain alter the antiresorptive 

potency of N-BPs in vivo.A series of experiments were conducted 

in which the ability of BPs to prevent protein prenylation in 

rabbit osteoclasts was recorded based on their ability to inhibit FPP 

synthase. FPP synthase activity was measured in homogenates of 

J774 macrophages (cells that undergo apoptosis following treatments 

with BPs in vitro, as a result of inhibition of protein prenylation). 

The enzyme substrate used was [14C] IPP. 16 Clodronate and 

etidronate were not included, since their inhibition was negligible at 

concentrations 100µM, in contrast to zoledronic acid or minodronate, 

which inhibited at concentrations 1nM. 16 Linear regression 

analysis demonstrated a significant correlation between antiresorptive 

potency of N-BPs and potency for inhibition of FPP synthase 

in J774 cell homogenates (r=0.95, prisedronate> ibandronate>incadronate> 

alendronate>pamidronate, consistent with the order of antiresorptive 

potency as illustrated in Table 1. 16 

The same study 16 using J774 cell homogenates also made a 

comparison between the potency of risedronate and NE58051 and 

between NE11808 and NE11809 (potent BP analogues that differ 

only by the R² side chain) for inhibiting rhFPP synthase. The study 

found risedronate to be almost 300-fold more potent at inhibiting 

rhFPP synthase than NE58051, whereas NE11808 was 73-fold more 

potent than NE11809. Consequently, there is a close overlap in the 

position of the nitrogen of the heterocyclic group in the conformation 

of risendronate and NE11808, the more potent inhibitors. This 

is in contrast to the less potent inhibitors NE58051 and NE11809, 

in which a close overlap of the nitrogen is not observed. This suggests 

that the orientation of the nitrogen atom is essential for the 

inhibition of FPP synthase in relation to the potency of BPs. 

Finally, BPs have shown anti-tumor properties by causing apoptosis 

of tumor cells through their action on the mevalonate pathway. 17 

In addition, bisphosphonates may also inhibit matrix metalloproteinases 

(MMPs) involved in cancer metastasis in vitro. 17 Recently, 

bisphosphonates have also exhibited anti-angiogenic properties by 

inhibiting endothelial cell functions, reducing bone blood flow asso- 

Figure 6. Treatment Guidelines for Management of Bisphosphonate- 

Associated Osteomyelitis/Osteonecrosis 5,18 

● 

● 

● 

● 

● 

● 

● 

● 

● 

Preventative 

Awareness of signs and symptoms, ie., infection, drainage, numbness 

in jaw, pain or swelling, delayed or poor healing of gingiva, 

exposed bone. 

Physicians should refer patients for oral health examinations and 

dental treatment prior to bisphosphonate treatment. 

Consultation 

If signs/symptoms exist, consultation with dentist, oral surgeon or 

oncologist should involve review of past medical history, including 

use and dosages of bisphosphonates. 

Obtain written consent for treatment, particularly surgical procedures, 

with acknowledgement of BON as potential complication. 

Nonsurgical Approach 

Conservative treatment to remove injured tissues or reduce sharp edges. 

Adjustments to dentures/soft relining. 

Obturators, protective mouthguards. 

Infection-specific antibiotic treatment (bacterial/fungal/viral). 

Oral rinses: chlorhexidine gluconate, minocycline hydrochloride. 

Figure 5. 

Simplified Version of Mevalonate Pathway 

Antiresorptive property of bisphosphonates in vivo is believed to result from their ability 

to prevent protein prenylation in osteoclasts following inhibition of FPP synthase. 

● 

● 

● 

Surgical Approach 

Surgical debridement under local anesthesia, sequestrectomy, marginal 

resectioning, should be avoided in case of IV agents, with 

selective consideration for patients on oral bisphosphonates. 

Modify treatment according to risk of ONJ evaluated with serum 

CTX*, with repeat test 3-6 months later. 

Consider discontinuing drug for CTX values

TABLE 2 

Recommendations for Bisphosphonate Dosage Levels Based 

Upon Patient’s Renal Function. 2 

Renal Function Serum Creatinine Recommendation 

Value (mg/dl) 

Normal Increased by 0.5 Hold next dose until value 

returns to within 10% 

of baseline. 

Abnormal Increased by 1.0 Hold next dose until value 

has returned to within 

10% of baseline. 

Normal/Abnormal Mild elevation, but Increase infusion time 

has returned to 10% &/or use larger volume 

of baseline 

of diluting fluids &/or delay 

administration of next dose. 

ciated with bone resorption and bone loss. 17 This process, along with 

the added demands on the bone to maintain vitality via remodeling 

and vascularity, predisposes the patient to avascular necrosis. 8 

Conclusion 

Despite the increasingly evident benefits of BPs as cancer therapy, preventative 

measures are critical to limit the risks associated with BPassociated 

osteomyelitis/osteonecrosis. Treatment recommendations 

for the management of oral complications are provided in Figure 6. 

The evidence presented in this case, in addition to others, suggests a 

possible association between BP therapy and ONJ, although a causal 

relationship has not yet been established. The rate of reported occurrence 

is low, perhaps because of a lack of awareness and an inability by 

clinicians to recognize and manage the potential oral complications 

associated with BPs. Thus, prior to BP therapy, a comprehensive dental 

examination and screening is recommended so that any sources of 

potential dental infections and other predisposing factors may be recognized 

and resolved, particularly dental extractions. 

Other procedures, including dental implants, surgical periodontal 

procedures and even biopsies, may further expose or injure 

bone, making it susceptible to the possible adverse effects of BP 

use. It is therefore recommended that clear communication take 

place among dental professionals, oncologists and patients to 

enable early detection of the possible oral complications associated 

with these drugs. Until then, further research addressing dosing 

aspects, duration, mechanism of action, outcomes of treatment, the 

effect of concurrent therapies and the effect of discontinuation of 

bisphosphonate therapy on healing are suggested. ■ 

Queries about this article can be sent to Dr. Grewal at vgdds@hotmail.com 

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therapy. J Can Dent Assoc 2005;71(2):111-3. 

4. Wooltorton E. Patients receiving intravenous bisphosphonates should avoid invasive 

dental procedures. JAMC 2005;172(13):1684. 

5. Edwards BJ, Hellstein JW, Jacobsen PL, Kaltman S, Mariotti A, Migliorati CA. Expert 

Panel Recommendations: Dental Management of Patients on Oral Bisphosphonate 

Therapy. Report of the Council on Scientific Affairs. ADA 2006;1-13. 

6. Lin JH. Bisphosphonates: a review of their pharmacokinetic properties (review article). 

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7. Santini D, Gentilucci UV, Vincenzi B, Picardi A, Vasaturo F, Cesa AL, Onori N, Scarpa S, 

Tonini G. The antineoplastic role of bisphosphonates: from basic research to clinical evidence. 

Annals of Oncology 2003; 14(10):1468-1476. 

8. Migliorati CA, Schubert MM, Peterson DE, Seneda LM. Bisphosphonate-associated 

osteonecrosis of mandibular and maxillary bone: an emerging oral complication of supportive 

cancer therapy. Cancer 2005;104(1):83-93. 

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of patients with bisphosphonate-associated osteonecrosis: an American Academy of 

Oral Medicine position paper. JADA 2005;136:1658-68. 

11. Martin JT, Grill V. Bisphosphonates-mechanisms of action. Australian Prescriber 2000; 

23(6):130-32. 

12. Markiewicz MR, Margarone III JE, Campbell JH, Aguirre A. Bisphosphonate-associated 

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13. Greenberg MS. Intravenous bisphosphonates and osteonecrosis (editorial). OOOOE 

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14. Carter G, Goss AN, Doecke C. Bisphosphonates and avascular necrosis of the jaw: a possible 

association. MJA 2005;182(8):413-15. 

15. Johnson T, Holder R, Johnson B. Bisphosphonate-related osteonecrosis of the jaws. 

Interface (newsletter). May/June 2005:4,7. 

16. Dunford JE, Thompson K, Coxon FP, Luckman SP, Hahn FM, Poulter CD, Ebetino FH, 

Rogers MJ. Structure-activity relationships for inhibition of farnesyl diphosphate synthase 

in vitro and inhibition of bone resorption in vivo by nitrogen-containing bisphosphonates. 

JPET 2001;296:235-242. 

17. Merigo E, Manfredi M, Meleti M, Corradi D, Vescovi P. Jaw bone necrosis without previous 

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Chicago: Quintessence 2007. 


Varinder S. Grewal, BsC., D.D.S., is a staff dentist at St. James 

Mercy Hospital in Hornell, NY. He was chief resident in the 

Department of General Dentistry at St. Joseph's Hospital and 

Medical Center, Paterson, NJ, and former resident at Brookdale 

University Hospital and Medical Center, Brooklyn, NY 

Dr. Grewal 

Edgar P. Fayans, D.D.S., is chairman of the Department of Dental 

and Oral Surgery at the Brookdale University Hospital and 

Medical Center, Brooklyn, NY.

Sequential Development of 

Multiple Supplemental Premolars 

Four-year Follow-up Report 

Rajesh T. Anegundi, M.D.S.; Anand Tavargeri, M.D.S.; K.R. Indushekar, M.D.S.; Pesapati Sudha, M.D.S. 

Abstract 

Multiple supernumerary teeth are usually associated with 

various syndromes, but they are relatively uncommon as 

an isolated dental anomaly. The presence of multiple supplemental 

premolars in all four quadrants and especially 

in the maxilla is rare. This report presents a unique case 

of multiple supplemental premolars in all four quadrants 

that were distributed unevenly (two erupted; five unerupted). 

A series of radiographs taken over four years demonstrated 

further sequential developing bilateral supplemental 

premolars in the maxilla, where they are considered the 

rarest. Appropriate management and the importance 

of regular radiographic monitoring of such cases are 

briefly reviewed. 

THE PRESENCE OF supernumerary teeth is a well-recognized clinical 

phenomenon that can be seen as single or multiple, unilateral 

or bilateral, impacted or erupted, in the mandible or maxilla or 

both. 1 The majority of supernumerary teeth have been reported in 

the premaxilla, followed by the mandibular premolar, maxillary 

molar regions and, rarely, in the canine and maxillary premolar 

regions. 2-4 

Supernumerary premolars have been reported to occur in 0.29 

percent of the general population and to represent between 8.0 per- 

cent and 9.1 percent of all supernumerary teeth. 3-6 Unlike other 

supernumerary teeth, supernumerary premolars are more likely to 

develop in the mandible than in the maxilla. There are only a few 

reported cases of supernumerary premolars in all four quadrants. 

A comprehensive study of supernumerary teeth was conducted 

by Stafne in 1932. 6 He examined full-mouth radiographic surveys of 

48,550 adults. A total of 500 supernumerary teeth were noted. Of 

these, only nine maxillary and 33 mandibular supplemental premolars 

were seen. It is unclear from Stafne’s description whether these 

42 teeth were distributed among 42 people or whether some of the 

subjects exhibited multiple supernumerary premolars. 

The etiology of supernumerary teeth is not clear, but several 

theories have been suggested as to how they arise. Originally, 

Oechlers, in 1952, suggested that they developed as a result of 

atavism. But this theory has been discarded. 8 A dichotomy theory 

was suggested by Gardiner in 1961. 9 It held that a complete, equal 

split of the tooth bud would result in two supplemental forms, 

whereas an unequal split would result in one normal tooth and one 

supernumerary tooth. This theory, however, fails to account for the 

development of the supplemental form because, if a permanent 

tooth bud splits during the initial tooth formation, the stage of 

development of the resultant supernumerary tooth should be 

almost the same as the corresponding normal tooth. 

Another theory suggested that it may be a result of hyperactivity 

of dental lamina. 10 

Over 20 syndromes and developmental conditions have been 

found to be associated with single and multiple supernumerary 

teeth developing as part of systemic conditions such as Gardner’s 

syndrome or cleidocranial dysplasia. However, the occurrence of 


multiple supernumerary teeth in the absence of an associated systemic 

condition or syndrome is a rare phenomenon. In an extensive 

review of non-syndromic association of supernumerary teeth, it 

was found that the mandibular premolar region was the most common 

site of occurrence for such teeth. 11 

Other proposed etiological factors include supernumerary 

dental germs and progressive zone theory, which suggests that the 

progress zone of the dental lamina at the end of every tooth series 

gives rise to the supernumerary tooth. 12 Brook suggested 13 a unified 

etiology theory based on a multifactorial model with a continuous 

scale and thresholds related to tooth number and sizes. This position 

on the scale depends upon the accumulative effect of genetic 

and environmental factors. Occasionally, a major effect may be 

caused by a chromosomal or single gene anomaly. This would 

account for finding supernumerary teeth in the presence of other 

anomalies. 

The case presented here documents multiple supernumeraries 

occurring in all four quadrants. What is important about this case 

is that it provides a series of panoramic radiographs taken over four 

years that showed sequential development of teeth in the maxillary 

premolar region. 

Case Report 

A 14-year-old healthy boy reported to the Department of Pediatric 

Dentistry at SDM College of Dental Sciences and Hospital in 

Dharwad, India, in August 2001 complaining of double teeth in the 

upper jaw. Intraoral examination revealed a permanent dentition 

stage with Angle’s Class I malocclusion with labially erupting maxillary 

left permanent canine and palatally erupted bilateral supplemental 

premolars (Figure 1). During routine investigation, an 

orthopantomograph revealed five additional unerupted supplemental 

premolars in varying developmental stages unevenly distributed 

in all four quadrants (Figure 2). There were two supplemental 

premolars between the mandibular right and left premolar, 

one each between the maxillary right and left permanent canine 

and the premolar region.All the supplemental premolars were situated 

in the apical third of the adjacent teeth. No other abnormalities 

were detected. Familial and medical history was insignificant. 

The lingual position of the supplemental premolars was confirmed 

by a mandibular occlusal radiograph. 

The presence of multiple unerupted supplemental premolars 

and the surgical procedure for removing the teeth were explained to 

the patient and his parent. Routine hematological investigations 

were done; the values were within the normal limits. Palatally 

erupted and left-side maxillary unerupted supplemental premolars 

were extracted, as they were displacing the canine labially. Surgical 

extraction of the supplemental maxillary right premolar, followed 

by the mandibular left and right premolars was carried out under 

local anesthesia. 

An Orthopantomograph taken after 18 months, in October 

2002, demonstrated two more sequential developments of bilateral 

supplemental premolars in the maxilla (Figure 3). The follow-up 

radiographs taken after 11 months, in August 2003, revealed two 

further developing supplemental premolars and satisfactory healing 

of the wound (Figure 4). 

Further follow-up radiographs taken after 36 and 48 months 

revealed well-developing supplemental premolars (Figures 5 & 6). 

Vitality tests were carried out periodically for erupted premolars, 

which were found to be vital. These tests were done mainly to determine 

the influence of developing supplemental premolars and to 

Figure 1. Maxillary arch with palatally erupted bilateral supplemental premolars. 

Figure 2. Orthopantomograph showing 7 supplemental premolars. 

Figure 3. Orthopantomograph after 18 months revealed developing new supplemental 

premolar on either side of maxilla. 


Figure 4 

Figure 5 

Figure 6 

Figures 4,5,6. Periodic Orthopantomograph at 29, 36 and 48 months revealed 

well-developing supplemental premolars. 

know whether surgical removal of the supplemental premolar has 

any effect on vitality, since these teeth were in close proximity to the 

apices of the erupted premolars. The case was monitored periodically 

to watch the sequential development of supplemental premolars. 

Discussion 

Supernumerary teeth resembling adjacent teeth are called supplemental 

teeth. In the case presented here, the coronal morphology 

resembled the premolar and, hence, the teeth can be called supplemental 

premolars. The occurrence of multiple and sequential 

development of supplemental premolars is relatively uncommon in 

the maxillary region. Poyton et al. 14 noted that the prevalence of 

supernumerary premolars is 1 in 10,000. However, Rubenstein et 

al. 15 reported a prevalence of 7 in 1,100. Bodin and coworkers 16 

found multiple supernumerary teeth in only 2 subjects out of 

21,609 subjects examined. King et al. reported three cases, with a 

total of 20 supernumerary premolars. 4 

Gulati and Gupta 17 reported a case with five supplemental premolars 

in the mandible and three in the maxilla. Moore et al. 

reported 18 multiple development of supplemental premolars in the 

mandibular region. Rubenstein et al. 15 reported a case with three 

supplemental premolars in the maxilla and 13 in the mandible. 

John Crean et al. 19 reported multiple supplemental premolars, about 

10, in all four quadrants. The present case is unique in that seven 

supplemental premolars were observed initially and later two more 

supplemental premolars were found developing in both sides of the 

maxilla, a rarity in this region. A review of the literature gives no 

information on why multiple and sequential developing supplemental 

premolars occur. 4-8,10 

The majority of supplemental teeth in the permanent dentition 

develop later than the norm for teeth in that particular area. 

Evidence of this is found in the incomplete root formation of the 

supernumerary tooth when compared with the complete root formation 

of teeth of the normal series. 6 However, it is difficult to 

determine exactly when a supplemental tooth starts to form 

because its lingual or palatal position makes detection difficult on 

routine radiographs. 7 Scott and Symons 20 said the calcification of 

permanent premolar teeth commences between 1.5 years of age 

and 2.5 years, although there may be no radiographic evidence of 

this until 3 or 4 years. But, it has been reported that supplemental 

premolar teeth develop approximately 7 to 11 years after normal 

tooth development. The time of initial supplemental premolar mineralization 

could be determined within two years. 15,21 

Most problems associated with supernumerary teeth are the 

result of their interference with the normal eruption and final position 

of adjacent teeth. Complications associated with multiple and 

sequential developing supernumerary teeth are retarded eruption, 

displacement, impaction and loss of arch space, 6,12,18 as canine displacement 

was seen in this case. 

Without a radiographic examination it is unlikely that supplemental 

premolar development would be detected. Seventy-five percent 

of supplemental premolars are unerupted and usually asymptomatic. 

6,14,15 Surgical removal of supernumerary teeth is the treatment 

of choice. In cases of impacted supplemental premolars, 

chances of injury to adjacent structures and trauma to the corresponding 

nerve during surgical removal should be kept in mind. 

When planning for surgical removal, supernumerary teeth should 

be evaluated carefully to determine the risk and benefits of surgery. 

King et al. 4 reported that if left untreated, supplemental premolars 

would erupt into the dental arch, thus avoiding the complications of 

surgery. The patient should be monitored periodically with radiographs 

for any developing pathology when left in situ. 

Conclusion 

Although many supplemental premolars in the mandibular region 

and few in the maxillary region were reported in the past, the case 


eported here is unusual because of the number of extra teeth present 

and the sequential development of supplemental premolars in 

the maxillary region. 

Detecting supernumerary teeth is best achieved through clinical 

and radiographic examination. Careful planning and surgical 

technique will allow the teeth to be removed successfully with no 

damage to the permanent dentition. Careful periodic monitoring 

by radiographs may reveal more sequentially developing supplemental 

premolars and is, therefore, mandatory. ■ 

Queries about this article can be sent to Dr. Tavargeri at anandtavargeri@yahoo.com. 

REFERENCES 

1. Spyropoulos ND, Patsakas AJ, Angelopoulos AP. Simultaneous presence of partial 

anodontia and supernumerary teeth. Oral Surg 1979;48(7):53-56. 

2. Mc Kibben DR, Brearley L J. Radiographic determination of the prevalence of selected 

dental anomalies in children. J Dent Child 1971;28(11,12):390-398. 

3. Grahnen H, Lindhal B. Supernumerary teeth in the permanent dentition: a frequency 

study. Odont Rev 1961;12:290-294. 

4. King NM, Lee AM,Wan PK. Multiple supernumerary premolar: their occurrence in three 

patients. Aust Dent J 1993;27:479-81. 

5. Nazif MM, Ruffallo RC, Zullo T. Impacted supernumerary teeth: a survey of 50 cases. J 

Am Dent Assoc 1983;106:201-204. 

6. Stafne EC. Supernumerary teeth. Dent Cosmos. 1932;74:653-659. 

7. Bowden DEJ. Postpermanent dentition in the premolar region. BDJ 1971; 131:113-116. 

8. Ochlers FAC. Postpermanent premolar BDJ 1952;93:157-158. 

9. Gardiner JH. Supernumerary teeth. Dental Practitioner and Dental Record 1961;12:63- 

73. 

10. Di Biase DD. Midline supernumerary teeth in Huston, Texas, school children. J Dent for 

Children. 1969;24:98-105. 

11. Yusof WZ. Non-syndrome associated multiple supernumerary teeth: literature review. J 

Canadian Dent Assoc 1990;56:147-149. 

12. Grimams GA, Kyriakides AT, Spuropoulos ND. A survey on supernumerary molars. 

Quintessence Int 1991;22:989-995. 

13. Brook AH.A unifying etiological explanation for anomalies of human tooth number and 

size. Arches of Oral Biology 1984; 29:373-378. 

14. Poyton GH, Morgan GA, Crooch SA. Recurring supernumerary mandibular premolars; 

Report of a case of post mature development. Oral Surg Oral Med Oral Pathol 

1960;13:964-966. 

15. Rubenstein LK, Lindaver SJ, Issacson RJ. Development of supernumerary premolars in 

an orthodontic population. Oral Surg Oral Med Oral Pathol 1991;71:392-395. 

16. Bodin I, Julin P, Thomsson M. Frequency and distribution of supernumerary teeth 

among 21609 patients. Dentomaxillofac Radiol 1978;7:15-17. 

17. Gulati MS, Gupta L. Multiple supernumerary premolars – a case report. J Indian Soc 

Pedo Prev Dent 1997;15:83-84. 

18. Moore SR,Wilson DF, Kibble J. Sequential development of multiple supernumerary teeth 

in the mandibular premolar region – a radiographic case report. Int J Pediatric Dent 

2002;12:143-145. 

19. Crean J, Cunningham S, Hardev SC. Multiple supernumeraries: a case report. Dental 

Update 1995; Oct:343-345. 

20. Scott JH, Symons NBB. Introduction to Dental Anatomy. 5th Ed. London:Churchill 

Livingstone. 1967. 

21. Kantor ML, Bailey CS, Burkes EJ. Duplication of the premolars dentition. Oral Surg Oral 

Med Oral Pathol 1988; 66:62-64. 


The Efficacy of Two UV 

Toothbrush Sanitization Devices 

A PILOT STUDY 

Julius R. Berger, D.D.S.; Mark J. Drukartz, D.D.S.; Mark D. Tenenbaum, D.M.D. 

Abstract 

The authors conducted a study to evaluate the efficacy of 

two different toothbrush sanitization machines for household 

use and to determine if one machine’s sanitizing 

power was superior to the other. Bacteria from the same 

individual were tested for six days using the same brand 

toothbrush and toothpaste at the same time of day. The 

toothbrushes were sanitized using the VIOlight and HIGH 

DENT. In 83% of cases with the VIOlight machine, the 

amount of bacteria decreased after being sanitized, 

whereas the HIGH DENT had a 100% decrease in bacteria. 

Eighty-three percent of brushes sanitized with HIGH 

DENT resulted in rare or no growth compared to only 33% 

of those sanitized with VIOlight. While both machines 

reduced the amount of bacteria present on the toothbrush, 

the HIGH DENT was 50% more effective than VIOlight in 

reducing the majority of bacteria on the toothbrush. 

IN RECENT YEARS, creating a more sanitary environment has 

become more important to Americans, a result of a new awareness of 

the risks of harbored bacteria in the home. The market for antibacterial 

products is growing,as people seek out items that will create a more 

sanitary home/living environment. Some of these products include 

machines that sanitize toothbrushes. They were brought to the market 

after studies were performed to establish whether toothbrushes 

contain bacteria that cause oral and/or systemic infections. 1-5 

While the oral cavity is known to house a variety of bacteria 6 

that can be transferred to a toothbrush during use, studies indicate 

that bacteria found naturally in the environment may also be transferred 

to a toothbrush, especially during storage. 

The ADA has a list of recommendations for toothbrush care 5 to 

help reduce the amount of bacteria left on a toothbrush after use. 

Recently, numerous products have become available to sanitize a 

toothbrush. The following experiment evaluated the efficacy of two 

different toothbrush sanitization machines for household use and 

sought to determine if one machine’s sanitizing power was superior 

to that of the other. 

Background 

Two similar studies have been completed that test the bacteriakilling 

power of toothbrush sanitizing machines. A study done by 

Glass and Jensen 7 tested the efficacy of the Pollenex DS60 Daily 

Dental Sanitizer. Specific strains of microorganisms were tested on 

72 sterile toothbrushes sanitized with the Pollenex sanitizer versus 

72 sterile toothbrushes that were not sanitized. The sanitized 

toothbrushes had a substantial reduction in the number of 

retained bacteria and yeast compared to the non-sanitized toothbrushes. 

The toothbrushes were also exposed to HSV I and 

Parainfluenza Virus Type III. The Pollenex DS60 Daily Dental 

Sanitizer consistently killed both viruses on the treated toothbrushes, 

whereas the viruses remained on the non-sanitized 

toothbrushes for at least 24 hours. 


TABLE 1 

Results of Swab Tracks After Using VIOlight and HIGH DENT 

Day: 1 2 3 4 5 6 

Control H Heavy Heavy Heavy Heavy Medium Medium 

Control V Medium Moderate Medium Heavy Medium Heavy 

H after sant. No Growth Rare Light Rare Rare Rare 

V after sant. Light Rare Light Rare Medium Moderate 

Control H: Swab taken from toothbrush after brushing with toothpaste before being put into HIGH DENT sanitization machine. 

Control V: Swab taken from toothbrush after brushing with toothpaste before being put into VIOlight sanitization machine. 

H after ster: Swab taken from toothbrush after being sanitized in HIGH DENT machine. 

V after ster: Swab taken from toothbrush after being sanitized in VIOlight machine. 

In the following experiment, only the amount of gram-negative and 

gram-positive bacteria was evaluated. Therefore, the toothbrushes 

were not sterile prior to being sanitized. 

Methods and Materials 

Two different UV light sanitizers were used in this experiment. The 

first was VIOlight, and the second was HIGH DENT. The same 

brand of toothbrush and toothpaste was used in testing each 

machine. The same patient was used for all the experiments, and 

swabs were taken around the same time of day. 

Each day, the patient brushed half of his mouth with one 

toothbrush and the other half with the other toothbrush half an 

hour after eating lunch. After brushing was completed, each toothbrush 

was rinsed in tap water, swabbed with a cotton tip applicator 

and transferred to a TSA II 5% SB petri plate labeled control. One 

toothbrush was placed into each machine and kept inside as per the 

manufacturer’s instructions. 

The toothbrush in the VIOlight apparatus was exposed to UV 

light for 10 minutes, while the other toothbrush, in the HIGH DENT 

machine, was exposed to UV light for 45 minutes. Each toothbrush 

was swabbed again with a cotton tip applicator and transferred to a 

TSA II 5% SB petri plate. The plates were sent to the microbiology 

lab for incubation of two days and evaluated for gram-negative 

and/or gram-positive growth. Only growths in the area of the swab 

tracks were recorded. The experiment was completed over six days. 

The results were categorized under the following system: 

heavy, medium, moderate, light, rare or no growth recorded. Heavy 

growth was determined if the swabbed area was completely filled 

with dense clusters of bacteria. Medium growth was determined if 

the swabbed area was filled with bacteria but not in dense clusters. 

Moderate growth was determined if the swabbed area was mostly 

full with lightly dense bacteria. Light growth was determined if the 

swabbed area had few lightly dense clusters of bacteria. Rare 

growth was determined if the swabbed area had a few isolated 

spots of bacteria. No growth was determined if the swabbed area 

had no bacteria present. 

Results 

Manufactures will often test the germ-killing ability of their product 

using specific types of bacteria. The types of bacteria tested may not 

be the same for each company or product. To date, there are no commercially 

available products that sterilize the bacteria from tooth- 

Above left, before toothbrush was sanitized. Above right, after toothbrush was 

sanitized with HIGH DENT. 

Above left, before toothbrush was sanitized. Above right, after toothbrush was 

sanitized with VIOlight. 


ushes. 8 Rather, such products only claim to sanitize the brush, 

meaning that 99.9% of the tested bacteria are killed, or should be. 

Specific amounts of bacteria were not evaluated, nor were 

species of bacteria differentiated in this experiment. The goal was 

simply to evaluate two products that claim to sanitize toothbrushes—the 

VIOlight and the HIGH DENT. 

In 83% of cases with the VIOlight machine, the amount of bacteria 

decreased after being sanitized, whereas the HIGH DENT had 

a 100% decrease in bacteria. Eighty-three percent of brushes sanitized 

with HIGH DENT resulted in rare or no growth compared to 

only 33% of brushes sanitized with VIOlight. 

Conclusion 

While both machines reduced the amount of bacteria present on 

the toothbrush, the HIGH DENT was 50% more effective than 

VIOlight in reducing the majority of bacteria on the toothbrush. 

This may be due to the length of UV light exposure the toothbrushes 

received during the sanitization process, though this 

aspect of the machines was not evaluated in this experiment. 

Regardless, the results of this pilot study support the idea that 

if one does not mind having to wait longer for his or her toothbrush 

to be sanitized, the HIGH DENT will reduce more bacteria than the 

VIOlight. 

Naturally, this pilot study should be expanded to include an 

increased number of subjects in a randomized manner. Such an 

expanded study could add additional information to our initial 

impressions about the efficacy of these two different machines. ■ 

Queries about this article can be addressed to Dr. Berger at bergerj@nychhc.org 

REFERENCES 

1. Svanberg M. Contamination of toothpaste and toothbrush by Streptococcus mutans. 

Scand J Dent Res 1978;86(5):412-4. 

2. Verran J, Leahy-Gilmartin AA. Investigations into the microbial contamination of toothbrushes. 

Microbios 1996;85(345):231-8. 

3. Kozai K, Iwai T, Miura K. Residual contamination of toothbrushes by microorganisms. 

ASDC J Dent Child 1989;56(3):201-4. 

4. Glass RT, Lare MM. Toothbrush contamination: a potential health risk? Quintessence Int 

1986;17(1):39-42. 

5. ADA Positions and Statements. ADA Statement on Toothbrush Care: Cleaning, Storage 

and Replacement. Council on Scientific Affairs, November 2005. Available at: 

http://www.ada.org/prof/resources/positions/statements/toothbrush.asp.Accessed Aug. 

1, 2006. 

6. Kazor CE et al. Diversity of bacterial populations on the tongue dorsa of patients with 

halitosis and healthy patients. J Clin Microbiol 2003;41(2):558-63. 

7. Glass RT, Jensen HG. The effectiveness of a UV toothbrush sanitizing device in reducing 

the number of bacteria, yeasts, and viruses on toothbrushes. J Okla Dent Assoc 

1994;84(4):28-8. 

8. Toothbrush care, cleaning, and replacement. JADA 2006; 137:415. 


Oral Health Status of New Yorkers 

Health Department report offers both good news and bad for dental professionals to ponder. 

H. Barry Waldman, D.D.S., M.P.H., Ph.D. 

A MAJOR COMPREHENSIVE REPORT produced at the end of 2006 

by the Bureau of Dental Health of the New York State Department of 

Health provides a detailed study of both the dramatic progress and 

the need for continuing improvement in the oral health of New York 

State residents. The reality is that despite improvements, “…oral 

disease still affects a large proportion of the New York State population, 

with disparities in oral health (among various population 

groups).” The entire, extensive report, including detailed percentages, 

is available online. 1 

Status 

Children from lower income groups experienced more dental caries 

and more untreated caries than their higher income counterparts. 

Hispanic, black and Asian third graders in New York City had 

more untreated dental decay than white, non-Hispanic children. 

Compared to their national counterparts, a higher percent of 

New York State and City third graders had untreated caries. 

By contrast, adults in New York State fared much better than 

corresponding populations elsewhere in the country with regard to 

tooth retention. In particular, a smaller proportion of New Yorkers 

were edentulous. However, similar to national trends, among residents 

of New York State, racial/ethnical minorities, females and 

individuals with less education had more tooth loss. Between 1999 

and 2003/2004, among New Yorkers: 

● 

● 

● 

The percent of minority adults that had a tooth extracted due 

to caries or periodontal disease increased, while there was a 

decrease in this rate among white, non-Hispanic adults. 

The rate of complete loss of teeth among blacks, Hispanics and 

other racial/ethnic minority individuals increased. 

Mortality rates from oral and pharyngeal cancers were higher 

among males than females, and higher among minority males 

than non-minority males. 

Prevention Measures 

Almost three-quarters of New York State’s population served by a 

public water system receives optimally fluoridated water. Fluoride 

tablets are used regularly by slightly more than one-quarter of third 

grade students in non-fluoridated areas upstate. Only about onethird 

of third graders have had sealants placed, with much lower 

rates among children in low-income families. 

A much higher percent of New York State third graders reported 

a dental visit in the past year than their national counterparts. 

But the following is also true: 

● A lower proportion of low-income third graders had a dental 

visit compared to higher income children. 

● Black and Hispanic adults were less likely to have visited a dentist 

in the past year than whites. 

● A smaller percent of New York State residents 25 years and 


● 

older with less than a high school education visits a dentist or 

had their teeth cleaned in the prior year than those who graduated 

from college. 

Younger women, women who are less educated, those who are 

black, unmarried and on Medicaid were less likely to visit a dentist 

during their pregnancy than their respective counterparts. 

Access to Care 

The number of dentists (15,291 as of July 1, 2006) per 100,000 population 

is well above the national rate. The number of dental hygienists 

(8,390) per population is slightly higher than the national rate. 

However, the distribution of dental professionals is geographically 

uneven. Many rural and inner city areas have shortages of dental 

professionals. Specialty services may not be available. The number 

of practitioners treating underserved populations is inadequate. 

New York State practitioner data are consistent with national 

findings with respect to the decline in the number of practitioners 

per population and the aging of the dental workforce. 

Except for the dental school enrollment of Asian/Pacific 

Islanders, which far exceeds the national level, enrollment of under- 

represented minority students at dental schools in New York State 

has not kept pace with national enrollment levels. 

In 2004, nearly $303 million was spent on Medicaid dental services 

in New York State, but only about one-quarter of the dentists 

in the state had at least one claim paid by Medicaid. 

Room for Improvement 

The Bureau of Dental Health rightfully exalts the numerous achievements 

in the oral health of New Yorkers, in particular, the accomplishments 

that were achieved at a higher rate than national averages. 

The bureau’s report similarly emphasizes areas in need of 

improvement, in particular, for members of minority populations, 

individuals in low-income families and those with less education. 

The bureau’s presentation can well serve as a blueprint for 

directions to be taken by New York State dental professionals. ■ 

REFERENCE 

1. NY State Department of Health, Bureau of Dental Health. The impact of oral disease in 

New York State, December 2006. Available at: http://www.nyhealth.gov/prevention/dental/docs/impact_of_oral_disease.pdf. 

Accessed Jan. 19, 2007. 


CONCRESCENCE 

Report of Rare Complication 

Samprati J. Badjate, B.D.S., M.D.S.; K.M. Cariappa, M.D.S., MOMS RCPS 

Abstract 

Concrescence is an uncommon developmental anomaly 

that may influence exodontia as well as periodontal, 

endodontic, orthodontic and even prosthodontic diagnosis 

and treatment planning. Unexpected complications 

arising from this condition may lead to legal complications. 

To minimize risk and adverse outcome of treatment, consideration 

should be given to recognizing this condition 

and, possibly, modifying treatment planning. This article 

presents an unsuspected case of concrescence with a 

review of the literature. 

IT IS PRUDENT for the clinician to evaluate carefully each patient 

and each tooth to be removed for the possibility and desirability of 

a surgical extraction technique.As a general guideline, the clinician 

should consider performing an elective surgical extraction when he 

or she perceives a possible need for excessive force to extract a 

tooth. Examples of this situation include dense bone, hypercementosis, 

severe dilacerations/hook, and divergent root. 1 

We present here an unsuspected case of concrescence giving 

rise to such a situation. 

Case Report 

A 39-year-old male patient referred to the Department of Oral and 

Maxillofacial Surgery, Manipal College of Dental Sciences, for 

extraction of a submerged maxillary left second molar. The patient 

reported his past medical history to be negative. Clinical and radiographic 

examinations revealed submerged maxillary left first and 

second molars and an impacted third molar. The maxillary left second 

molar was grossly decayed (Figure 1). The patient was told of 

the impacted maxillary left third molar and consent was obtained 

for extraction of the maxillary left second and third molars. 

After explaining the possible complications, a surgical extraction 

was planned. Forceps extraction of the maxillary left second 

molar was attempted to get more access for surgical removal of the 

impacted maxillary left third molar. However, when the maxillary left 

second molar was extracted, the adjacent maxillary left third molar 

came with it (Figure 2). The buccal cortical plate was fractured but 

was attached with periosteum. There was no fracture of the tuberosity 

and no sinus perforation. There was primary wound closure. 

Sutures were removed after 10 days, and healing was satisfactory. 

Specimen radiographs were taken with a paralleling technique 

at two different exposure times. The first radiograph, with exposure 

of 0.6 second, showed minimal connection between the two teeth 

(Figure 3). But a second radiograph, with 0.3-second exposure 

time, showed fusion between the roots of two teeth, which is diagnostic 

of concrescence (Figure 4). 

Discussion 

Alterations in the shape of teeth can be germination, fusion or concrescence. 

Germinated teeth are anomalies that arise from an 

attempt at division of a single tooth germ by an invagination with 

resultant incomplete formation of two teeth. The structure usually 

consists of two completely or incompletely separated crowns that 


Figure 3. Specimen 

radiograph with 0.6- 

second exposure 

showing minimal contact 

between maxillary 

left second and 

third molars. 

Figure 4. 

Specimen radiograph 

with 0.3-second 

exposure time 

showing fusion of 

root cementum 

between two teeth. 

Figure 1. X-ray showing submerged maxillary left first and second 

molars and impacted third molar. 

Figure 2. Concrescence between maxillary 

left second and third molars. 

have a single root and root canal. It is most commonly seen in anterior 

teeth, which results in the formation of the two totally separate 

or partially separate crowns. 2,3,4 

Fused teeth arise from the union of two normally separated 

tooth germs and can happen at the level of enamel, dentine, cementum 

or pulp tissue. 2,3 The etiology is unknown, but both trauma and 

a familial tendency have been suggested as possible causes. 5,6 It is 

also thought that some physical force or pressure produces contact of 

the developing teeth and their subsequent fusion. 7 The extent of 

fusion depends upon the developmental stage at which it occurs. If it 

occurs before calcification begins, the two teeth unite to form a single 

tooth of near normal size. If it occurs at the later developmental 

stage, a single tooth with an enlarged or bifid crown results. A single 

enlarged root or two roots may be observed. Fusion is more common 

in deciduous teeth. 3,8,9-11 Clinical problems related to appearance, 

spacing and periodontal condition have been reported. 12 

Concrescence of teeth is actually a form of fusion that occurs 

during root formation or after the radicular phase of development 

is complete. Therefore, the union is only in the cementum of the 

adjacent teeth. 2,3,10,13 The amount of union may vary from one small 

site to a solid cemental mass along the entire extent of the root. 

Two adjacent roots become fused by deposition of cementum 

between them after the resorption of interdental bone, which may 

be secondary to traumatic injury, crowding or chronic inflammation 

(for example, a carious lesion). 7,14-16 

The detection of concrescence is important because of the 

potential complication it poses during exodontia and endodontics. 

2,3,4,7,8,14,17 It is impossible to detect clinically and may defy radiographic 

detection as well when it may be misdiagnosed as simple 

radiographic overlap or superimposition of adjacent teeth, as 

in the case reported here (Figure 1). Therefore, it is important to 

consider this possibility when the roots of adjacent teeth are radiographically 

indistinguishable. Radiographs with different angulation 

and exposure parameters may aid in diagnosis. In the case 

presented here, specimen radiographs with two different exposure 

times were taken. The radiograph with less exposure time 

shows clear fusion between the roots of the two teeth (Figure 4). 

Clinicians may consider concrescence if unexplained difficulty 

is encountered with extraction of a tooth, particularly in the maxil- 

lary position area where the anomaly is commonly seen. 

Concrescence teeth can give rise to complications, such as an 

extraction of an adjacent tooth, fracture of the tuberosity or floor of 

the maxillary sinus. Therefore, it is very important to inform the 

patient about the condition and potential complications. In such 

cases, sectioning should be considered to minimize adverse and 

unexpected outcomes. 

Conclusion 

The diagnosis of concrescence occurs mainly after a surgical mishap. 

Therefore,it is important for clinicians to be aware of this odontogenic 

anomaly in order to minimize adverse and unexpected outcomes. In 

the planned case, sectioning of the tooth should be considered. ■ 

Queries about this article can be addressed to Dr. Badjate at drsam.prati@rediffmail.com 

REFERENCES 

1. Peterson, Ellis, Hupp, Tucker (editors). Contemporary Oral and Maxillofacial Surgery. 

3rd Edition. India: Harcourt Pvt. Ltd. 1998. 191-193. 

2. Herandez-Guisado JM. Dental germination: report of a case. Med Oral 2002;7:231-6. 

3. Eversole LR. Clinical Outline of Oral Pathology: Diagnosis and Treatment. 2nd Edition. 

Philadephia: Lea and Febiger. 1981. 318-9. 

4. McCoy-Collins RA, Tatum RC, Marfatia-Rege A. Fused maxillary second and third 

molars: report of a rare case with literature review. J Md State Dent Assoc 1988;31:102-5. 

5. Regezi JA, Sciubba J. Abnormalities of teeth. In: Oral Pathology: Clinical-Pathologic 

Correlations. Philadelphia:WB Saunders. 1993. 494-501. 

6. Wiggs RB, Lobprise HB. Developmental Pathology. In:Veterinary Dentistry: Principles 

and Practice. Philadelphia: Lippincott Raven. 1997.105-112. 

7. Shafer WG, Hine MK, Levy BM. Text Book of Oral Pathology. 4th Edition. 

Philadephia:Saunders. 1983. 38-40. 

8. Kaffe I, Litttner M, Begleiter A, Buchner A. Fusion of permanent molars. Quintessence 

Int. 1982. 11:237-9. 

9. Graubard SA. Fusion of a lower second and third molar and macrodontia of a lower first 

molar. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1977;44:817. 

10. Killan CM, Kroll TP. Dental Twinning Anomalies: The Nomenclature Enigma. 

Quintessence Int 1990;21:571-6. 

11. Grahnen H, Granath LE. Numerical variations in primary dentition and their correlation 

with the permanent dentition. Odontol. Rev 1961;12:348. 

12. Mader CL. Fusion of teeth. J Am Dent Assoc 1979;98:62. 

13. Peterkova R, Peterka M,Viriot L, Lesot H. Dentition development and budding morphogenesis. 

J Craniofac Genet Dev Biol 2000;20:158-72. 

14. Mader CL. Concrescence of teeth: a potential treatment hazard. Gen Dent 1984;32:52-5. 

15. Linn EK. Concrescence:a case report. Gen Dent 1998;46:338-339. 

16. Neville BW, Damm DD, Allen CA, Bouquot JE. Oral and Maxillofacial Pathology. 2nd 

Edition. Philadelphia: Saunders 2002. 76-7. 

17. Law L, Fishelberg G, Skribner JE, Lin LM. Endodontic treatment of mandibular molars 

with concrescence. J Endod 1994; 20:562-4. 


Why Do I Have White Spots 

on My Front Teeth? 

Elvir Dincer, D.D.S. 

Abstract 

Aesthetics have always been important in mainstream society. 

Fluorosis, a condition of hypomineralization of the 

enamel, is at its most critical stage when a child is between 

22 and 25 months of age. Because their swallowing reflex 

is not fully developed, children under the age of 6 can 

swallow between 25% and 33% of fluoridated toothpaste 

with each brushing. In order to better educate parents 

about fluorosis and its effect on children’s teeth, it is worth 

revisiting the guidelines for toothpaste use. 

WITH ESTHETICS GAINING more ground in today’s society, white 

spots on the maxillary front anterior teeth can be a great concern 

for parents and their children. Fortunately, this condition can be 

prevented. Since the introduction of fluoridated drinking water in 

1945, the rate of cavities has decreased. Brushing with fluoridated 

toothpaste lowers the risk of cavities by 15% to 30%, and drinking 

fluoridated water can lower the risk of cavities by 18% to 40%. 1 

Did you know that most children’s and adult’s toothpaste contain the 

same amount of fluoride? It’s also fact that children’s toothpaste 

tastes much better. The problem arises when a 2 year old, who cannot 

spit on demand, ends up swallowing the toothpaste. This situation 

becomes more noticeable around the age of 7, when the maxillary 

central incisors erupt with white spots. This condition is known 

as enamel fluorosis (also known as fluorosis, or dental fluorosis). 

Enamel fluorosis is a condition in which hypomineralization 

of the enamel occurs because excessive amounts of fluoride were 

ingested during tooth development. It can occur on any tooth. 

The signs of fluorosis can be a mild case of white spots (Figure 

1)—which is most common—to a more severe case of pitting 

and mottling of the enamel (brownish discoloration). The maxillary 

incisors are most susceptible to enamel fluorosis, with the 

most critical period being when a child is between the ages of 22 

and 25 months. 2 Such changes in the tooth’s appearance can 

affect the child’s self-esteem, which makes early prevention that 

much more critical. 

Fluoride Exposure on Rise 

Exposure to fluoride can be attributed to other sources as well, 

including baby formula mixed with fluoridated water, soft drinks 


TABLE 1 

Dietary Fluoride Supplement Schedule 

Approved by the American Dental Association, the American Academy 

of Pediatrics, and the American Academy of Pediatric Dentistry. 

Fluoride ion level in drinking water (ppm)* 

Age less than 0.3 - 0.6 ppm greater than 

0.3 ppm 0.6 ppm 

Birth - 6 months None None None 

6 months - 3 years 0.25 mg/day** None None 

3 - 6 years 0.50 mg/day 0.25 mg/day None 

6 - 16 years 1.0 mg/day 0.50 mg/day None 

Figure 1. Case of mild fluorosis on incisal areas of teeth 7, 8, 9, 10 with extrinsic 

yellowish-brown staining. (Photo courtesy Neal G. Herman, DDS, clinical professor, 

Department Pediatric Dentistry, NYU College of Dentistry.) 

1 part per million (ppm) = 1 milligram/liter (mg/L) 

** 2.2 mg sodium fluoride contains 1 mg fluoride ion. 

Source: CDC-National Center for Chronic Disease Prevention and Health 

Promotion. Dietary Fluoride Supplement Schedule. 

http://www.cdc.gov/Oral Health/factsheets/fl-supplements.htm 

produced from areas with fluoridated water, fluoride mouthrinses 

and certain foods. Because of increased exposure to fluoride, the 

Centers for Disease Control found a 9% higher prevalence of enamel 

fluorosis in American children than was found in a similar survey 

20 years earlier. 3 

Studies also show there is a prevalence of fluorosis both in fluoridated 

and non-fluoridated communities. 4,5 

Such excessive fluoride ingestion at an early age tends to affect 

the incisors and first molars, whereas later ingestion affects the 

canines, premolars and second molars. 6 Since many children start 

to brush their teeth before the age of 2 (mostly, 18 to 24 months), 7,8 

this group will most likely be affected by enamel fluorosis. Children 

under 6 years of age can swallow up to 25% to 33% of fluoridated 

toothpaste with each brushing (usually, twice a day, if not more), 9 

because their swallowing reflex is not fully developed. 10 Furthermore, 

parents currently have less time to supervise their children’s 

brushing habits because of their busy schedules. One study notes 

that supervision of toothbrushing was below the recommended 

amount for 2- to 3-year-old children. 11 

As dental professionals, our concern should be determining the 

amount of fluoridated toothpaste being applied to a child’s toothbrush, 

as well as who is applying the toothpaste—the parent or child? 

We know a child should use a pea-size amount of toothpaste. But did 

you know that different cultures consider peas to be different sizes 

(Figure 2)? For instance, someone from Latin America may consider 

the size of a pea to be quite different from an individual born in India. 

As oral health care professionals, we need to be aware of the 

message parents get from advertisements suggesting covering the 

entire toothbrush with toothpaste (Figure 3A). The question is, how 

many parents read the directions on the toothpaste tube, which 

says to use only a pea-size amount with supervision? A strip of 

toothpaste covering the toothbrush head contains 15-times the 

amount of fluoride of a pea-size amount of paste. 12 Naccache et al. 

Figure 2. Different sizes pea can be for parent, alongside child-size toothbrush. 

Figure 3. Toothpaste placements. 

3A. Toothpaste placed along length of adult-size toothbrush. 

3B. Toothpaste placed along length of child-size toothbrush. 

3C. Toothpaste placed along width of child-size toothbrush. 

found that the overall mean fluoride ingestion was 0.23 mg F from 

a 0.21 g of 1100 ppm fluoride paste ingested by children whose ages 

ranged from 2 to 7 years. 13 

Guidelines Limit Fluoride Exposure 

Guidelines established in 1994 and followed by the American 

Dental Association, the American Academy of Pediatrics and the 

American Academy of Pediatric Dentistry (Table 1) suggest that 

children from the age of 6 months to 3 years should not have 

more then 0.25 mg F/day. Brushing the teeth of a 2 year old twice 

a day will expose the child to 0.46 mg F/day (0.23mg F/day times 

2), exceeding the allowable limits of fluoride (0.25 mg F/day for 


the 6-month to 3-year age group) if they spit out all the toothpaste, 

and without factoring in the other daily sources of available 

fluoride, such as water, soft drinks, fluoride mouthrinses 

and certain foods. 

If the child should swallow the toothpaste, which is likely given 

the pleasant flavor, then the child is at even greater risk for enamel 

fluorosis. 

In response to fluoride concerns, the British Society of 

Paediatric Dentistry recommended in a 1996 study that children 

under the age of 7 use low-fluoride toothpaste. 14 

Education Key to Prevention 

Enamel fluorosis is a condition requiring further research. The 

most important thing to do with a parent on the initial dental visit 

is to discuss completing a three-day intake diary for the child, 

starting from the moment the child wakes up, through bedtime 

and noting everything placed in the child’s mouth, including 

toothpaste, liquids and food. Parents should be completely forthcoming 

with their observations of the child’s brushing habits and 

if the child spits or swallows all or some of the toothpaste. If the 

child is prone to swallowing the paste, it may be best to brush the 

child’s teeth with simply a wet toothbrush without toothpaste 

until the child learns to spit out properly. 

As to the amount of toothpaste used, I usually suggest to 

parents that they place toothpaste along the width of the toothbrush 

(Figure 3C) rather than along the length of the toothbrush 

(Figure 3B). This will be a closer representation of what constitutes 

“pea size.” 

The parent should be present with the child during brushing 

from start to finish and not reapply toothpaste between child and 

parent brushing. The toothpaste should only be applied once for 

each brushing session. Children should also use a child-size 

toothbrush to ensure they receive an appropriate amount of 

toothpaste. Not only can use of an adult-size toothbrush injure the 

child, it will also increase the amount of toothpaste the child 

could potentially swallow. 

Keep in mind that many older children are assisting their parents 

by taking care of their younger siblings; therefore, it is important 

to discuss toothbrushing with them as well. 

Finally, I discuss this not only with parents whose children are 

present but also with expecting parents. This is a topic that should 

be reviewed with both parents. 

By incorporating these simple elements into your child’s 

brushing practice, enamel fluorosis can be limited, if not prevented, 

and increase the child’s self-esteem to smile. ■ 

Queries about this article can be addressed to Dr. Dincer at edincer@hostos.cuny.edu. 

REFERENCES 

1. Szpunar SM, Burt BA. Trends in the prevalence of dental fluorosis in the United States: a 

review. J Public Health Dent 1987; 47: 71-79. 

2. Osuji OO, Leake JL, Chipman ML, Nikiforuk G, Locker D, Levine N. Risk factors for dental 

fluorosis in a fluoridated community. J Dent Res 1988;67(12):1488-1492. 

3. Beltrán-Aguilar ED, Barker LK, Canto MT, Dye BA, Gooch BF, Griffin SO, Hyman J, 

Jaramillo F, Kingman A, Nowjack-Raymer R, Selwitz RH, Wu T. Surveillance for Dental 

Caries, Dental Sealants, Tooth Retention, Edentulism, and Enamel Fluorosis—United 

States, 1988-1994 and 1999-2002. National Center for Chronic Disease Prevention and 

Health Promotion, Division of Oral Health. MMWR: August 26, 2005; 54(03):1-44. 

4. Pendrys D, Katz R, Morse D. Risk factors for enamel fluorosis in a nonfluoridated population. 

Am J Epidemiol 1996;143: 808-815. 

5. Evans RW, Stamm JW. An epidemiologic estimate of the critical period during which 

human maxillary central incisors are most susceptible to fluorosis. J Public Health Dent 

1991;51:251-259. 

6. Horowitz H. Proper use of fluoride in fluoridated communities. (Commentary) The 

Lancet May 1, 1999;Volume 353 (9163): p.1462. 

7. Levy SM, Maurice TJ, Jakobsen JR. Dentifrice use among preschool children. J Am Dent 

Assoc 1993;(124): 57-60. 

8. Simard PL, Naccache H, Lachapelle D, Brodeur JM. Ingestion of fluoride from dentifrices 

by children aged 12 to 24 months. Clin Pediatr 1991;30:614-617. 

9. Franzman MR, Levy SM, Warren JJ, Broffitt B. Fluoride dentifrice ingestion and fluorosis 

of the permanent incisors. J Am Dent Assoc 2006;137(5):645-652. 

10. Mascarenhas AK, Burt BA. Fluorosis from early exposure to fluoride toothpaste. 

Community Dent Oral Epidemiol 1998;26:241-248. 

11. Wyne AH, Spencer AJ, Szuster FS. Toothbrushing practices of 2-3 year old children and 

their age at first dental visit: a survey in Adelaide, Australia. Int J Paediatric Dent 

1997;7(4):263-264. 

12. Holt RD, Murray JJ. Developments in fluoride toothpaste—an overview. Commun Dent 

Health 1997;14(1): 4-10. 

13. Naccache H, Simard PL, Trahan L, Brodeur JM, Lachapelle D, Bernard PM. Factors affecting 

the ingestion of fluoride dentifrice by children. J Public Health Dent. Summer 1992; 

52(4): 222-226. 

14. Holt R., Nunn J, Rock P, Page J. British Society of Paediatric Dentistry. BSPD Policy 

Document: Fluoride Dietary Supplements and Fluoride Toothpastes for Children. Int J 

Paediatric Dent. 1996;6:139-142. 


Author’s Credit 

Elvir Dincer, D.D.S., is assistant professor in the Dental Hygiene Program at 

Eugenio Maria de Hostos Community College of the City University of New 

York. 

Dr. Dincer

Sodium Hypochlorite Chemical Burn 

Case Report 

Seth T. Farren, D.D.S.; Rory S. Sadoff, D.D.S.; Kevin J. Penna, D.D.S. 

Abstract 

Sodium hypochlorite (NaOCl) is a well documented and 

widely accepted intracanal irrigant used to disinfect the 

pulp space in endodontic therapy. NaOCl can be an 

extremely cytotoxic material; therefore, care must be taken 

with its use. The authors present a case of periradicular 

extravasation of NaOCl with sequelae of pain, swelling, 

ecchymosis and parasthesia consistent with a chemical 

burn. The patient was treated with a nonsurgical medical 

management approach. She experienced a complete resolution 

of signs and symptoms, aside from a persistent 

residual focal parasthesia. 

NAOCL IS A PROTEOLYTIC material that has been used as an 

intracanal irrigant for over 85 years. 1 It has the ability to dissolve 

necrotic tissue and debris, in addition to providing lubrication for 

mechanical debridement. 2 However, if the material comes in contact 

with vital soft tissue outside of the canal system, it can be 

extremely cytotoxic and destructive, causing side effects consistent 

with the properties of a chemical burn. 3 

There have been few reported cases of untoward incidents 

involving NaOCl injection into periradicular tissues describing a 

soft tissue response and sequelae. The following report describes a 

case of severe, exaggerated soft tissue response with pain, swelling, 

ecchymosis and parasthesia, secondary to periradicular extravasation 

of NaOCl during routine endodontic therapy. A nonsurgical 

medical management approach was taken, resulting in complete 

resolution of soft tissue swelling and pain, although the patient has 

experienced persistent focal parasthesia. 

Case Report 

A 54-year-old female was referred to the Oral and Maxillofacial 

Surgery service at Nassau University Medical Center (NUMC) by 

her treating endodontist. The details given by the referring 

endodontist included a history of nonsurgical root canal therapy 

for the upper left first premolar (#12) earlier that morning. The 

patient experienced a sudden onset of pain and swelling in the left 

cheek, and treatment was discontinued abruptly. 

The canal was irrigated with copious amounts of distilled water 

and sealed with a provisional bridge from the upper left first premolar, 

extending to the upper left first molar (#12-#14). The patient 

was immediately sent to NUMC for evaluation and treatment. 

The initial interview with the patient revealed a past medical history 

significant for mitral valve prolapse, hypothyroidism and stroke, 

which occurred 15 years ago with no resultant functional disturbances. 

She reported taking synthroid 100 mcg QD for thyroid hormone 

replacement and amoxicillin 2 g for prophylaxis against subacute 

bacterial endocarditis. She reported a history of adverse reaction 

to lidocaine with epinephrine, resulting in palpitations. She subsequently 

had dental work with Mepivicaine devoid of vasoconstrictor 

with no untoward sequelae. No other drug allergies were reported. 

The patient presented with no evidence of respiratory distress and 

no complaints of dysphagia. The initial physical exam revealed stable 

vital signs. She did exhibit a supple, warm, left-side facial swelling 

extending inferior to the left zygomatic arch and superior to the left 

body of the mandible. A bluish hue was present at the fullest extent of 

the facial swelling (Figure 1). The ocular exam revealed no significant 

findings. The facial and oral exam revealed no evidence of trismus; the 

uvula was in midline; and her tongue was supple. Intraoral soft tissues 

were within normal limits. A provisional restoration extended from 

tooth #12 to tooth #14, with tooth #13 being a pontic (Figure 2). 

The provisional bridge was removed from teeth #12 through #14 

and debris was removed from the canal of tooth #12 (Figure 2). The 

canal system was irrigated with normal saline. The patient was placed 


Figure 1. Initial presentation of patient one hour 

after periapical extravasation of NaOCl. Extent of 

facial swelling demarcated with surgical marker. 

Figure 2. Tooth #12 after removal of provisional bridge and 

extirpation of canal material. 

Figure 3. Patient presentation at follow-up 

day 16 with complete resolution of facial 

swelling and ecchymosis. 

on penicillin Vee K 500 mg for one week. She was also given vicodin ES 

(7.5 mg/750 mg) for pain. She was instructed to place ice packs on her 

face (20 min on / 20 min off) for one day and to perform saline rinses 

five times a day. The facial swelling was outlined with a blue surgical 

marker, and the patient was asked to return the next day to follow the 

demarcation of this noxious injury. She was advised that it might 

progress and require surgical intervention and possible hospitalization. 

The patient was followed daily. By post-op day two, the facial 

swelling was unchanged except for increasing ecchymosis. The area 

of infraorbital paranasal parasthesia had decreased in size. Marked 

improvement was seen by post-op day four, with a decrease in 

swelling and tissue color changing from red to yellow. Facial 

swelling and color had completely resolved to normal by post-op 

day nine. Because of improvement in the patient’s condition, the 

provisional bridge was replaced with a temporary luting agent. 

At 16 days, the patient’s clinical presentation had returned to 

baseline except for a persistent area of focal parasthesia from the 

left infraorbital foramen to the nasal-labial fold of approximately 

1.5 cm x 1.0 cm in size (Figure 3). 

Discussion 

Extravasation of NaOCl into periradicular tissues can result in an 

aggressive tissue reaction that can be very alarming to the patient 

and the clinician. This tissue response is violent and disproportionate 

to the amount of NaOCl in contact with the tissue. 4 The typical 

sequence of injury begins with excruciating pain (lasting three to five 

minutes) and immediate tissue swelling. Profuse hemorrhage develops 

within the area involved and can manifest in excessive bleeding 

through the tooth. 5 Focal parasthesia and esthetic defects are possible 

sequelae and are related to the amount of tissue destruction. 

NaOCl is a proteolytic material that has the ability to oxidize, 

hydrolyze and osmotically draw fluids out of tissues. This material 

has effective action against necrotic and vital tissue alike. 6 It has 

been shown to be cytotoxic in concentrations as low as 0.25%, 

much lower than the 5.25% concentration found in standard 

household bleach, a common irrigant used in endodontic therapy. 7 

Managing inadvertent introduction of NaOCl into periapical 

vital tissue is based on three principles: 1. minimizing swelling; 

2. pain management; and 3 prevention of secondary infection. 

Swelling can be controlled by methods ranging from conservative 

treatment with icepacks to multiple areas of incision and drainage. 

Leaving an open canal system in the treated tooth will provide the 

clinician with an easily obtainable area for drainage. 

Nonsurgical management may be all that is necessary when 

treating this complication. Pain management is crucial for these 

patients because the process is acutely painful in the immediate 

aftermath, with moderate-to-severe pain lasting two to three days. 

Antibiotic therapy is necessary to prevent secondary infection, 

which can occur from bacterial debris in the canal being pushed 

into periradicular tissue and extensive amounts of necrotic tissue 

and dead space within the area of tissue destruction. 

Prevention is always the best form of management; therefore, special 

attention should be paid to open apexes, root resorption and 

overinstrumentation of the canal.When irrigating, end orifice delivery 

needles should be used with caution. They should never be lodged in 

the canal, and irrigant should never be delivered under positive pressure. 

Side orifice delivery needles are a safer alternative. Furthermore, 

1% buffered NaOCl is recommended to minimize cytotoxic effects. 8,9 

Sound principles can help minimize the risk for a sodium 

hypochlorite accident, and, in the event of this complication, aid in 

achieving a successful outcome in the treatment of these patients. 

Medical management alone may prove to be adequate for this 

aggressive tissue response, but surgical intervention must be considered 

if there is progression of this noxious event. ■ 

Queries about this article can be addressed to Dr. Farren at sfarren@NUMC.edu. 

REFERENCES 

1. Crane AB.A Practicable Root Canal Technique. 1st Ed. Philadelphia: Lea & Febiger 1920:69. 

2. Ehrich DG, Brian JD, Walker WA. Sodium hypochlorite accident: inadvertent injection 

into the maxillary sinus. J Endodo 1993;19:180-2. 

3. Pashley EL, Birdsong NL, Bowman K, Pashley DH. Cytotoxic effects of NaOCl on vital tissue. 

J Endodo 1985;11:525-8. 

4. Sabala CL,Powell SE.Sodium hypochlorite injection into periapical tissues.J Endo 1989;15:490-2. 

5. Mehra P, Clancy C, Wu J. Formation of a facial hematoma during endodontic therapy. 

JADA 2000;131:67-71. 

6. Gatot A,Arbelle J, Leiberman A,Yanai-Inbar I. Effects of sodium hypochlorite on soft tissues 

after its inadvertent injection beyond the root apex. J Endodo 1991:17:573-4. 

7. Heggers JP, Sazy JA, Stenberg BD, Strock LL, McCauley RL, Herndon DN, Robson MC. 

Bactericidal and wound-healing properties of sodium hypochlorite solutions: The 1991 

Lindberg Award. J Burn Care Rehabil 1991;12:420-4. 

8. Byström, A, Sundqvist G. The antibacterial action of sodium hypochlorite and EDTA in 

60 cases of endodontic therapy. Int Endod J 1985;18;35. 

9. Byström, A, Sundqvist G. Bacteriological evaluation of the effect of 0.5 percent sodium 

hypochlorite in endodontic therapy. Oral Surg Oral Med Oral Pathol 1983:55;307. 


Drug Utilization Pattern in Dental Outpatients 

in Tertiary Care Teaching Hospital in Western Nepal 

Subish Palaian, M.Pharm; P. Ravi Shankar, M.D.; Chatura Hegde, M.D.S.; 

Manjunath Hegde, M.D.S.; Pradip Ojha, B.Pharm.; Pranaya Mishra, M.Pharm, Ph.D. 

Abstract 

A high incidence of dental disease has been reported in 

Nepal. Previous studies, both in the Manipal Teaching 

Hospital, Pokhara, Nepal, and other centers revealed problems 

in the use of medicines in dentistry. A number of initiatives 

to improve prescribing have been carried out. The study 

presented here was undertaken to assess the impact of these 

initiatives on drug utilization among dental outpatients. 

The study was conducted among patients attending 

the dental outpatient department of the hospital over a sixmonth 

period. Demographic details were studied. The 

drug classes and individual drugs prescribed were 

recorded. The cost of drugs was calculated using the outpatient 

pharmacy price list. The prescriptions were analyzed 

using the WHO/INRUD prescribing indicators. 

Anomalies were noted in prescribing. Improvement 

was noted in certain parameters compared to previous 

studies. The educational initiatives should be strengthened. 

Managerial interventions can be considered. 

Further studies are required. 

NEPAL IS A DEVELOPING COUNTRY in South Asia. A study conducted 

by Basnyat and coworkers had reported a high incidence of 

dental diseases in Kathmandu, Nepal. 1 A study of drug utilization 

among dental outpatients was carried out at the BP Koirala 

Institute of Health Sciences (BPKIHS), Dharan, Eastern Nepal. 2 The 

study revealed that dental caries was the most common dental disease, 

that antimicrobials were frequently prescribed and that use of 

fixed-dose combinations (FDCs) was routine. 

Drug utilization research (DUR) is defined by the World Health 

Organization as “The marketing, distribution, prescription and use 

of drugs in a society, with special emphasis on the resulting medical, 

social and economic consequences.” 3 Pharmacoepidemiology is the 

study of the use and effects/side effects of drugs in a large number of 

people with the purpose of supporting the rational and cost-effective 

use of drugs in the population, thereby improving health outcomes. 3 

The goal of DUR is to facilitate the rational use of drugs in 

populations. Besides, knowledge of how drugs are prescribed and 

used is essential to initiate a discussion of rational drug use and to 

suggest measures to improve prescribing habits. 3 DUR helps to generate 

early signs of rational drug use and may be helpful to suggest 

interventions to improve drug use. DUR will be helpful to frame 

drug policy decisions to improve drug use. 

The Manipal Teaching Hospital (MTH) is a tertiary care hospital 

attached to the Manipal College of Medical Sciences (MCOMS) 

in Pokhara, Nepal. The use of analgesics 4 and the drug prescribing 

practices of dentists 5 in MTH were studied previously. These studies 

were, however, conducted in 2001 and 2002. They recommended 

developing prescribing guidelines and educational initiatives to 

improve prescribing. 

Since 2002, a number of initiatives have been carried out to 

improve prescribing in the teaching hospital. A hospital drug and 

therapeutics committee (DTC) was formed, consisting of staff from 


the departments of hospital and clinical 

pharmacy, pharmacology, medicine, 

administration and other clinical departments. 

The DTC has undertaken a number 

of initiatives to improve prescribing. 6 

Restricting the number of brands in the 

hospital pharmacy and creating a hospital 

drug list were some of the initiatives carried 

out. 7 The department of pharmacology 

runs a drug information and pharmacovigilance 

center (DIPC) in the teaching 

hospital. The impact of these initiatives 

on prescribing patterns in dentistry was not studied. Hence, the 

present study was carried out. 

The objectives of the study were to: 

1. Obtain information on the age, sex distribution and geographic 

distribution of patients attending the dental outpatient 

department during the study period. 

2. Study the classes of drugs prescribed and the most common 

individual drugs. 

TABLE 1 

Age Distribution of Patients (n=424) 

Age Group (Yrs) Number Percentage 

Less than 10 55 12.97 

10-20 94 22.17 

21-30 93 21.93 

31-40 57 13.44 

41-50 47 11.08 

51-60 36 8.49 

61-70 24 5.66 

> 70 16 3.77 

Not mentioned 2 0.47 

Drug utilization research 

is defined by the World Health 

Organization as “The marketing, 

distribution, prescription and use 

of drugs in a society, with special 

emphasis on the resulting medical, 

social and economic consequences.” 3 

3. Study the dosage forms prescribed and 

the average cost per prescription. 

4. Analyze the prescriptions according to 

the World Health Organization (WHO)/ 

International Network for the Rational Use 

of Drugs (INRUD) prescribing indicators. 

Method 

The study was carried out among patients 

attending the dental outpatient department 

of the Manipal Teaching Hospital 

from February 5 to August 4, 2006. 

Demographic details like age, sex, diagnosis and the district 

the patient was from were studied. The common drug categories 

and individual drugs prescribed were noted. The dosage 

form of the drugs, instructions for use and duration of prescription 

were recorded. 

The cost of drugs was calculated using the price list available 

in the outpatient pharmacy of the hospital. The cost of different 

drug groups and of individual drugs was studied. The proportion 

of the total cost contributed by different groups and by individual 

drugs was calculated. The common drug groups and top five individual 

drugs were listed. 

The prescriptions were analyzed using the WHO/INRUD prescribing 

indicators. The number of encounters with an antimicrobial 

and an injectable prescribed were calculated. The mean ± SD 

number of drugs per prescription was calculated. The number of 

drugs prescribed from the essential drug list of Nepal and the WHO 

model list of essential drugs was obtained. The number of drugs 

prescribed from the hospital drug list, the Nepalese National 

Formulary (NNF) and the percentage of drugs prescribed by generic 

name were calculated. The number of encounters with a narcotic 

analgesic prescribed was worked out. 

TABLE 2 

Diagnosis of Patients (n=424) 

S.No Diagnosis Number Percentage 

1 Periapical abscess 249 58.73 

2 Chronic generalized gingivitis 45 10.61 

3 Irreversible pulpitis 52 12.26 

4 Generalized periodontitis 18 4.25 

5 Localized periodontitis 13 3.07 

6 Apthous ulcers 6 1.42 

7 Localized gingivitis 5 1.18 

8 Pericoronitis 4 0.94 

9 Pericoronal abscess 4 0.94 

10 Oral candidiasis 3 0.71 

11 Periodontal abscess 3 0.71 

12 Dentinal hypersensitivity 2 0.47 

13 Acute alveolar osteitis 1 0.24 

14 Miscellaneous 19 4.48 

Results 

A total of 424 patients were prescribed drugs during the study period. 

The total number of drugs used was 665. Of the 424 patients, 202 

(47.64%) were males, and 220 (51.89%) were females. Details 

regarding the gender of two patients were not available. 

A higher number [94 (22.17%)] of patients were in the age 

group 10 to 20 years. The age distribution of the patients is shown 

in Table 1. 

The majority of patients (nearly 56%) were diagnosed as having 

periapical abscess, seen as a complication of untreated dental 

caries. Details regarding the diagnosis of the patients are listed in 

Table 2. 

The majority (84.43%) of the patients were from Kaski district, 

in which the city of Pokhara is located. Patients also came 

from the neighboring districts of Syangja (3.30%), Parbat (2.36%), 

Tanahu (1.89%) and Baglung (1.42%). The remainder of the 

patients (6.62%) was from other places. 


Analgesics were the most common class of drugs prescribed in the 

study population. Paracetamol accounted for 4.21% of the total 

drugs. Although paracetamol is mainly antipyretic, with mild analgesic 

action, it was prescribed here in the patients in whom ibuprofen 

and other NSAIDs could not be tolerated. Details regarding the 

drug categories are listed in Table 3. 

Ibuprofen was the most common drug used in 228 (41.16%) 

patients,followed by amoxicillin [194 patients (35.02%)] and chlorhexidine 

[60 patients (10.83%)]. Doxycycline [42 prescriptions (7.58%)] 

and Piroxicam [30 prescriptions (5.42%)] were also commonly used. 

Among the total of 665 drugs, the majority [592 (89.02%)] were oral 

drugs and the remaining 73 (10.98%) were topical drugs. 

The instructions available with the prescriptions were studied. It 

was found that 26 (4.36%) drugs were prescribed once daily, 112 

(16.84%) were twice daily, 405 (60.90%) were three-times daily, and 1 

(0.155) four-times daily. Thirty (4.51%) were prescribed on an asrequired 

basis.Details regarding 88 drugs (13.23%) were not available. 

Of the 424 prescriptions, 30 were for medications prescribed 

only on an as-required basis and, hence, were excluded from the 

cost analysis. The remaining 394 prescriptions were analyzed for 

cost. The mean ± SD cost per prescription was Nepalese rupees 

(NPR) 83.89 ± 91. 32 (1.17 ± $1.28 US). Details of the cost analysis 

of the prescriptions are listed in Table 4. 

Antibiotics accounted for 69.22% of the total drug cost (NPR 

35571.11). Details of the cost analysis based on the drug category is 

listed in Table 5. 

The total cost of the top five individual drugs was calculated. 

These drugs accounted for NPR 31935.88. Of this amount, amoxicillin 

accounted for 74.52%, followed by chlorhexidine (12.62%), 

ibuprofen (7.29%), piroxicam (4.655) and the FDC of ibuprofen+paracetamol 

(0.92%). 

It was found that 662 (99.55%) of the drugs were prescribed 

from the hospital drug list and 563 (84.7%) were from the Nepalese 

national formulary. There were no narcotic drugs prescribed for the 

patients. Detailed analysis of the prescriptions based on WHO/ 

INRUD indicators is provided in Table 6. 

Discussion 

Analgesics and antibiotics were the most commonly prescribed class 

of drugs. Ibuprofen and amoxicillin were the most commonly prescribed 

individual drugs. Antibiotics, antibacterial cleansing agents 

and analgesics accounted for the majority of the drug cost. A large 

percentage of the drugs was prescribed from the hospital drug list and 

the essential drug list of Nepal. Prescribing by generic name was low. 

The number of female patients was marginally higher in our 

study, and the majority of patients was in the 10 to 20 and 21 to 30 

year age groups. The gender and age distribution was in broad conformity 

with that reported in the census of Nepal. 8 Periapical 

abscess, irreversible pulpitis—both arising from untreated dental 

caries—and chronic generalized gingivitis were the most common 

diagnoses. In a study in Eastern Nepal, the most common dental 

TABLE 3 

Drug Classes Used (n=665) 

Therapeutic Classification No. of Drugs Percentage 

Analgesics 278 41.80 

Antibiotics 254 38.20 

Antibacterial cleansing agents 64 9.62 

Antipyretics 28 4.21 

H2 antihistaminics 15 2.26 

B-complex 8 1.20 

Others 18 2.71 

TABLE 4 

Cost Analysis 

Cost (NPR) Number of Prescriptions Percentage 

0-50 128 32.49 

50-100 89 22.59 

100-150 130 32.99 

150-200 30 7.61 

200-250 9 2.28 

250-300 3 0.76 

>300 5 1.27 

TABLE 5 

Cost Based on Therapeutic Category 

Therapeutic Classification Total Cost (35571.11) Percentage 

Antibiotics 24622.2 69.22 

Antibacterial cleansing agents 5002.00 14.06 

Analgesics 4268.47 12 

Antipyretics 270.53 0.76 

Vitamin B-complex 261.53 0.74 

Medicated toothpaste 213.66 0.6 

Antifungals 175.23 0.49 

Antipyretic muscle relaxants 167.04 0.47 

Pancreatic enzyme 132.66 0.37 

Iron preparations 122.1 0.34 

H2 antihistamines 79.76 0.22 

Proton pump inhibitors 77.34 0.22 

Topical anesthetics 55.11 0.15 

Multivitamins 51 0.14 

Others 72.5 0.2 

TABLE 6 

Analysis of Drug Use According to WHO/INRUD 

Prescribing Indicators 

Parameter Prescription (%) 

Average number of drugs per prescription 2.97 

Number of encounters with an injectable prescribed 0 (0) 

Number of fixed dose combinations 50 (7.51) 

(FDC) prescribed 

Number of drugs prescribed from 592 (89.02) 

the essential drug list of Nepal 

Number of drugs prescribed from WHO EDL 583 ( 87.66) 

Number of encounters with an 254 (38.19) 

antimicrobial prescribed 

Number of generic drugs prescribed 45 (6.76) 

NNF- Nepalese National Formulary, WHO EDL- WHO essential drug list 


diseases were dental caries, periodontitis, pericornal abscess and 

chronic gingivitis. 3 A high prevalence of dental caries and periodontitis 

was observed in Kathmandu 2 and in India. 9 A previous 

study had hypothesized that the high incidence of dental disease in 

developing countries might be related to inadequate oral hygiene, 

which could result from rapid urbanization, low school attendance 

and lower rates of adult literacy. 10 

The majority of patients in our study were from the Kaski district, 

in which the city of Pokhara is located. This was followed by 

the neighboring districts of Syangja, Parbat, Tanahu and Baglung. 

This was similar to what was observed previously in a study of outpatients 

in our teaching hospital. 11 

Analgesics, antibiotics and antibacterial cleansing agents were 

the most used drug categories. In a study in Eastern Nepal, antimicrobials, 

NSAIDs, multivitamins and oropharyngeal preparations 

were the most commonly prescribed drugs in the dental department. 

3 In India, antimicrobials and NSAIDs were most commonly 

prescribed. 12 In a previous study in our hospital, 

the most commonly prescribed systemic 

agents were analgesics and antimicrobials, 

while the most commonly used topical agents 

were anti-infectives. 5 

The average number of drugs per prescription 

in our study was 2.97. In a previous 

study in Eastern Nepal, the mean number of 

drugs was 2.79. 3 In a previous study in our 

hospital, the mean number of drugs was 2.03. 5 

In a study in India, the mean numbers of 

drugs was 2.4. 12 The high number of drugs 

prescribed in our study is a matter of concern. 

It reemphasizes the need to carry out educational and other initiatives 

to reduce the number of drugs prescribed. 

It is an encouraging result that parenteral dosage forms of 

drugs were not prescribed. In a previous study also, all analgesics 

were prescribed orally. 4 In a previous study in Eastern Nepal, only 

1.12% of prescriptions contained an injection. 

The most commonly used individual drugs were ibuprofen, 

amoxicillin, chlorhexidine, doxycycline and piroxicam. The use of 

antibiotics and analgesics was most common. In Eastern Nepal, 

multivitamins, antibiotics and analgesics were the most commonly 

prescribed drugs. 3 This was also observed in a previous study in our 

hospital, 5 in which NSAIDs were preferred over narcotic analgesics. 5 

Ibuprofen was the most frequently prescribed systemic analgesic, 

while amoxicillin was the most frequently prescribed antibiotic. 

Amoxicillin and doxycycline were the most commonly used 

antimicrobials. A study conducted in Nigeria had shown that penicillin 

V, metronidazole, ampicillin, a combination of ampicillin and 

cloxacillin, erythromycin and tetracycline were commonly prescribed. 

13 In Nepal, amoxicillin, metronidazole, doxycycline, tinidazole, 

the fixed dose combinations (FDCs) of amoxicillin and 

cloxacillin, ampicillin and cloxacillin were commonly prescribed. 3 


Analgesics and antibiotics were 

the most commonly prescribed 

class of drugs. Ibuprofen and 

amoxicillin were the most 

commonly prescribed 

individual drugs. 

The mean cost per prescription was NPR 83.89 Nepalese rupees 

(US $1.17). Antibiotics, antibacterial cleansing agents and analgesics 

accounted for the maximum percentage of the cost. 

Amoxicillin, chlorhexidine and ibuprofen were the individual drugs 

accounting for the maximum cost. 

There were no encounters with an injection prescribed. Fifty of 

the 665 drugs (7.5%) were FDCs. In a previous study, 33% of drugs 

were FDCs. 5 In a previous study in India, 45% of drugs were FDCs 

and the FDC of ampicillin and cloxacillin was the most commonly 

prescribed antimicrobial. 12 The use of FDCs should be low, as not all 

components of a FDC may be required in an individual patient and 

the FDC may not provide the requisite amount of individual drugs. 

In our hospital, the FDC of ampicillin and cloxacillin is banned by 

the hospital DTC and, hence, not available in the hospital. 

Antimicrobials were prescribed in 254 of the 424 encounters 

(59.9%). In India, 73.3% of all prescriptions contained an antimicrobial 

agent (AMA). 12 In the United Kingdom,antibiotic prescription was 

a characteristic of 30% of patients. 14 

Antibiotics were frequently prescribed without 

generally accepted criteria, and there was a 

wide variation in prescribing. This study was 

carried out among patients presenting with 

acute dental conditions. In Eastern Nepal, 

79.9% of prescriptions contained AMAs. In 

Nigeria, antibiotics were included in 82.1% of 

the prescriptions. 13 In a previous study in our 

hospital, 66% of prescriptions contained an 

AMA. 5 The number has marginally decreased 

in the present study. In general, it is advisable 

to prescribe fewer antimicrobials. 

Narcotic analgesics were not prescribed in our study. In a previous 

study, 10.3% of analgesics administered orally were opoids. 4 

In the USA, a combination of hydrocodone with acetaminophen 

was prescribed most frequently for 64% of respondents. In our hospital, 

guidelines for the use of analgesics and other drugs were 

absent. The use of non-opoid analgesics is to be welcomed but the 

retrospective nature of the study prevents us from making firmer 

observations regarding the rationality of drug use. 

Does the present study show an improvement in dental prescribing 

practices compared to a previous study? 5 The mean number 

of drugs has increased. Narcotic analgesics were not used in the 

present study compared to 10.4% previously. The percentage of prescriptions 

containing AMAs has decreased marginally. The most 

commonly prescribed drugs were similar. The overall improvement 

in prescribing was not substantial. 

Antibiotics are invaluable adjuncts in the management of orofacial 

infections. 16 The appropriate and correct use of antibiotics 

ensures that effective and safe treatment is available and practices 

that increase microbial resistance are avoided. Improving the 

teaching of pharmacology in dental education and continuous 

assessment of dental practices have been suggested. 16

A study in the UK has shown that a clinical audit, with guidelines 

and an educational component, can change the prescribing practices 

of dentists and lead to a more rational and appropriate use of 

antibiotics. 17 The hospital (MTH) is in the process of framing 

antimicrobial use guidelines for various departments. Guidelines 

for the use of other classes of medicines should also be considered. 

The study had a few limitations. It was carried out in a single 

hospital in Nepal. Drug use was analyzed quantitatively using the 

WHO/INRUD indicators. Reasons for the particular prescribing 

practices observed were not analyzed qualitatively. The rationale 

for using prescriptions also was not analyzed. The study was carried 

out over a six-month period, and seasonal variations in drug 

use were not studied. Drug use was not measured using the defined 

daily dose (DDD) concept. 

Conclusions 

The study presented here reports on drug utilization among dental 

outpatients in a teaching hospital in Western Nepal. The number 

of drugs prescribed from the hospital drug list and essential 

drug list of Nepal was high. The average number of drugs per prescription 

was high, but generic prescribing was low. Educational 

initiatives have been conducted to improve prescribing. These initiatives 

have to be strengthened. Managerial interventions can be 

considered. The creation of guidelines for the use of medicines in 

dentistry should be considered. Studies for a longer duration of 

time and analysis of the rationality of prescriptions are required. ■ 

Queries about this article can be sent to Dr. Palaian at subishpalaian@yahoo.co.in 

REFERENCES 

1. Basnyat RT, Shreatha P. Dental caries and periodontal disease in Kathmandu. J Int Med 

1991; 13:15-28. 

2. Rauniar GP, Shahanas MS, Das BP, Niga Rani MA. A prospective study of dental disease 

pattern and drug utilization at the dental department of tertiary care teaching hospital 

in Eastern Nepal. JNMA J Nep Med Assoc 2001;40:6-11. 

3. Introduction to drug utilization research. World Health Organization 2003. 

4. Sarkar C, Das B, Baral P. Analgesic use in dentistry in a tertiary hospital in Western 

Nepal. Pharmacoepidemial Drug Saf 2004;13:729-33. 

5. Sarkar C, Das B, Baral P.An audit of drug prescribing practices of dentists. Indian J Dent 

Res 2004:15:58-61. 

6. Mishra P, Alurkar VM, Subish P. Functions of a drug and therapeutics committee in 

Nepal. J Pharm Pract Res 2006; 31: 81 

7. Mishra P. Enhancement of consumer safety and rational use of drugs: an important role 

of drug and therapeutics committee (DTC). HAI News 2005;132/133:22-23. 

8. Central Bureau of Statistics.Population Monograph of Nepal.Volume I.Kathmandu,Nepal:2003. 

9. Rajaratnam J, Devi S, Asirvatham M et al. Prevalence and factors influencing dental 

problems in a rural population of Southern India. Trop Doct 1995; 25: 99-100. 

10. Muira H, Amaki Y, Haraguehi K , Arai Y, Umenai T. Socioeconomic factors and dental 

caries in developing countries: a cross-national study. Soc Sci Med 1997;44: 269-72. 

11. Lamichane DC,Giri BR.Pathak OK,Panta OB,Shankar PR.Morbidity profile and prescribing patterns 

among outpatients in a teaching hospital in Western Nepal. McGill J Med 2006; 9:126-133. 

12. Rehan HS, Singh C, Tripathi CD, Kela AK. Study of drug utilization pattern in dental OPD 

at tertiary care teaching hospital. India J Dent Res 2001;12:51-6. 

13. Ogunbodede EO, Falusi AO, Folayan MO, Olayivola G. Retrospective study of antibiotic 

prescriptions in dentistry. J Contemp Dent Pract 2005; 6: 64-71. 

14. Thomas DW, Satterthwaite J,Absi EG, Lewis MA, Shepherd JP.Antibiotic prescription for 

acute dental conditions in the primary care setting. Br Dent J 1996;181:401-4. 

15. Moore PA, Nahaurari HS, Zovko JG,Wisniewski SR. Dental therapeutic practices in the US 

II. Analgesics, corticosteroids and antibiotics. Gen Dent 2006; 54:201-7; quiz 208,221-2. 

16. Epstein JB, Chong S. A survey of antibiotic use in dentistry. JADA 2000; 131:1600-09. 


2007 ANNUAL INDEX 

K E Y : 

J-January 

F-February 

M-March 

A-April 

MY-May 

AUTHOR INDEX 

JJ-June/July 

AS-August/September 

O-October 

N-November 

D-December 

Abraham, Jenny DDS: M20-22. 

Ad-El, Dean MD: AS48-51. 

Akgul, Nilgun DDS PhD: A28-32. 

Almog, Dov M. DMD: J51-53. 

Ari, Nilgun MSc: J40-42. 

Asgari, Ali DDS: A38-41. 

Aydin, Cemal DDS PhD: N38-41. 

Bal, Bilge Turhan DDS PhD: N38-41. 

Banta, Lois: D5. 

Bayirli, Gunduz: J58-60. 

Berkowitz, Gary S. DDS: A14-15. 

Bhagwat, S.V. BDS MDS: M23-29. 

Bhat, Gopalkrishna PhD: A20-22. 

Boulos, Paul J. DDS: A24-27. 

Bowman, S. Jay DMD MSD: AS42-47 

Brandes, Irene DDS PC: A14-15. 

Bretz, Walter A. DDS DrPH: JJ40-45. 

Buchanan, L. Stephen DDS: O3. 

Calikkocaoglu, Senih DDS PhD: J40-42. AS52-54. 

Chaberek, Slawomir: M41-45. 

Cusumano, Francis J. DDS: J57. 

Da Silva, Keith: A42-44. AS55-57. 

Dililbasi, Ertain DDS PhD: N38-41. 

Friedman, Kurt DDS MS: A34-37. 

Galler, Jeffrey DDS: J34-38, J96. 

George, Thomas MDS: N48-51. 

Ghoddusi, Jamileh DDS MSc: A46-49. JJ46-47. N52-53. 

Goldberg, Kenneth L. DMD: A14-15. 

Gonzalez, Yoly M. DDS: N32-35. 

Gupta, Preet DDS: JJ20-27. 

Halick, Frederick J. DMD. D1-2. 

Hamlin, David A. DMD: A14. 

Hauben, Daniel J. MD: AS48-51. 

Hazlewood, Arthur I. DDS MPH: J48-50, D12-13. 

Henner, Kevin A. DMD: F4. MY3. D3. 

Hershkin, Adam T. DMD: N46-47. 

Hoexter, David L. DMD: M30-32. 

Ilday, Nurcan Ozakar Med Dent: A28-32. 

Ilguy, Dilhan: J58-60. 

Ilguy, Mehmet: J-58-60. 

Jacobson, Barry L. DMD: A38-41. 

Joffe, Eugene DDS PhD: N42-45. 

Karakosca, Secil DDS: N38-41. 

Karaoglanoglu, Serpil DDS PhD: A23-32. 

Kaurani, Mayank BDS MDS: M23-29. 

Kerpel, Stanley M. DDS: AS64-66. 

Kreitzberg, Glen DDS: N54-56, D4. 

Kursoglu, Pinar DDS PhD: J40-42. AS52-54. 

Larsen, Charles D. DMD MS: M33-37. 

Larsen, Michael D. PhD: M33-37. 

Laurenzano, Robert DMD: M10-11. 

Levin, Liran DMD: JJ48-50. AS48-51. 

Lopez-Abrams, Betsy: O2. 

Lopez-Jornet, Pia MD PhD: N36-37. 

Lozier, Elizabeth B.: N32-35. 

Mahajan, Sumita MDS: 48-50. 

Mandel, Louis DDS: J54-56; A42-44. 

Margolin, Robert DDS: A14-15. 

Mehra, Pravesh MDS: M38-40. 

Mehta, Abhishek MDS: A20-22. 

Mehta, Manisha DMD: 38-41. 

Meshulam-Derazon, Sagit MD: AS 48-51. 

Milles Maano DDS: JJ51-53. 

Miller, Edward J. DMD: N46-47. 

Mirra, Richard M. DDS: J57. 

Moskowitz, Elliott DDS MSd: J4-5, M4-5,A16-19, JJ4,AS4, N4. 

Mounce, Rich DDS: JJ54-56. 

Mupparapu, Muralidhar DMD MDS: JJ51-53. 

Nilgan, Ari MSc: AS52-54. 

Oen, Kay DDS: A14-15. 

Ostrowski, Kazimierz: M41-45. 

Ozdabak, Nur Dr. Med. Dent: A28-32. 

Palat, Milton DDS: JJ20-27. 

Park, Mimi J.Y. DDS: J54-56. 

Penna, Kevin J. DDS: J57. 

Perrino, Michael A.: AS38-41. 

Pfail, John L. DDS: A38-41. 

Pisano, Dominic DMD: JJ51-53. 

Pradeep, A.R. MDS: J43-47. AS61-63. 

Quaranta, Patrick DMD: JJ51-53. 

Ramano, Paul R. DDS, MS: J51-53. 

Rinaggio, Joseph DDS MS: JJ51-51-53. 

Rosenbaum, Michael S. DMD: M33-37. 

Rossi, Margaret Surowka JD: J6-7, M6-8, A6, MY2, AS6-10. 

Sanaan, Azadeh DDS: 46-49. 

Schmidt, Edgard F. DDS MS: JJ40-45. 

Schork, M. Anthony PhD: AS30-37. 

Sequeira, Peter Simon MDS: A20-22. 

Segelnick, Stuart DDS: M46-49. JJ20-27. 

Shahrami, Fatemeh DDS MSc: A46-49. 

Sharma, Dileep C.G. MDS: J43-47. AS61-63. 

Shimizu, Hiroshi DDS Phd: JJ28-30. AS58-60. 

Schissel, Marvin J. DDS: N16. 

Singer, Steven R. DDS: JJ51-53. 

Singh, Harmeet BDS: M38-40. 

Srikant, Natarajan MDS: N48-51. 

Stavisky, Elena DMD: M33-37. 

Takahashi, Yutaka DDS Phd: JJ28-30. AS58-60. 

Tichler, Howard M. DDS MScD: M20-22. 

Truhlar, Mary Rose: D14-15. 

Urbanowska, Elzbieta: M41-45. 

Vatanpour, Mehdi DDS: JJ46-47. N52-53. 

Veitz-Keenan, Analia DDS: A14-15. 

Velez, Ines DDS MS: A34-37. 

Waldman, H. Barry DDS MPH PhD: J61-62. MY4. O8. D14-15. 

Weinberg, Mea A. DMD: M46-49. 

Weintraub, Jane A. DDS MPH: M14-19. 

Winter, Alan A. DDS: N28-30. 

Wojtowicz, Andrzej: M41-45. 

Yesil, Zeynep Duymus DDS PhD: A28-32. JJ32-38. 

Yilmaz, Handon DDS PhD: N38-41. 

Zarei, Mina DDS MSc: JJ46-47. N52-53. 

SUBJECT INDEX 

A 

ABRAHAM, JENNY E. 

Management of a Congenitally Missing Maxillary Central 

Incisor. M20-22. 

ADA 

Federal Agency Accepts ADA Recommendations for 

Professionally Applied Topical Fluoride. A53. 

Fewer Heart Patients Need Antibiotics before Dental 

Procedures. MY6. 

Mark Feldman Installed ADA President. N24. 

ADA Honors New York Volunteers. N60. 

ADDENDUM 

Patients from Mars, Patients from Venus. (Jeffrey Galler DDS). 

J96. 

ADDICTIONS 

UMDNJ Dental School in Cooperative Program to Treat 

People with Addictions. J66. 

AD-EL, DEAN 

Self-Reported Smith Satisfaction – Smile Parameters and 

Ethnic Origin Among Israeli Male Young Adults (Liran 

Levin DMD; Sagit Meshulam-Derazon MD; Daniel J. 

Hauben MD; Dean Ad-El MD). AS 48-51. 

AESTHETIC DENTISTRY 

The Social Six Redux – Is That Really All There Is? (S. Jay 

Bowman, DMD MSD). AS42-47. 

Self-Reported Smith Satisfaction – Smile Parameters and 



Hauben MD; Dean Ad-El, MD). AS 48-51. 

ALFANO, MICHAEL 

Second Annual Foundations of Excellence Awards. J24-25. 

ALMOG, DOV M. 

CT-Based Dental Imaging for Implant Planning and 

Surgical Guidance. (Dov M. Almog DMD; Paul R. 

Romano DDS, MS). J51-53. 

ALPORT SYNDROME 

Report of a Case of Severe Maxillofacial Manifestations 

(Kurt Friedman, DDS MS; Ines Velez, DDS MS). A34-37. 

AMALGAM 

Approval Given to EPA/ADA Specification for Storing and 

Shipping Dental Amalgam Waste. A52. 

ANESTHESIA 

Academies of Pediatric Dentistry and Pediatrics Issue 

Sedation Guidelines. J64. 

Dental Researchers Test No-Needle Anesthesia, No-Drilling 

Cavity Care. M52. 

ANTERIOR GUIDED OCCLUSION 

Anterior Maxillary Resin-Bonded Fixed Partial Denture to 

Preserve Occlusal Surface Area for Anterior Guidance 

(Hiroshi Shimizu DDS PhD; Yutaka Takahashi DDS 

PhD). JJ28-30. 



January 

February 

March 


ANTIBIOTICS 



Benefits of Additional Courses of Systemic Azithromycin 

in Periodontal Disease (Edgard F. Schmidt DDS MS; 

Water A. Bretz DDS DrPH). JJ40-45. 

APPOINTMENTS 

Upstate, Downstate Components Name New Executive 

Director. J10. 

Columbia County Dentist Reappointed to AES Position. J67. 

College of Dentistry Names CFO. M51. 

NYU Names California Dean to Head College of Dentistry. 

JJ58. 

ARI, NILGUN 

Using Tissue Conditioner Material in Neutral Zone 

Technique. J40-42. 

Use of Stafne’s Mandibular Defect in Improving Retention 

of Mandibular Complete Dentures (Pinar Kursolgu, 

DDS; Nilgun Ari MSc; Senih Calikkocaoglu DDS Phd.). 

AS52-54. 

AST, DAVID B. 

New York State Fluoride Pioneer Dies at 104. M51. 

AWARDS/PRIZES/HONORS 


Council Selects Paul Leary to Receive Tillis Award. J26. 

State Health Official Receives ADA Council Award. J67. 

California Educator, NYSDA Past President Nominated for 

Association’s Top Awards. MY1. 

New Dentist Leadership Award. JJ5. 

NYU Professor Honored. JJ60. 

Foundation Presents First-Ever Deans Awards. AS26-27. 

Fauchard Academy Honors Steven Gounardes. AS88. 

Six Organizations Receive Foundation Give Kids a Smile 

Award. O6. 

NYU Professor Receives Grant for HIV Research. O15. 

Sugarless Wednesday Program Receives ADA Golden 

Apple. O20. 

NYSDA Honors California Dean Emeritus. N18. 

Two Organizations Rewarded by Dental Foundation/Henry 

Schein Cares Partnership. N26. 

NYU College of Dentistry Awarded Grant to Develop 

Fracture-Resistant Restorations. N57. 

NYU College of Dentistry Names Associate Dean for 

Clinical Affairs. D20 

B 

BACTERIA 

Photodynamic Therapy Seen as Effective Alternative 

Therapy for Periodontal Disease. MY11. 

BACTERIAL CONTAMINATION 

Bacterial Contamination and Decontamination of 

Toothbrushes after Use (Abhishek, Mehta BDS; Peter 

Simon Sequeira MDS; Gopalkrishna Bhat PhD). A20-21. 

BAYER, WILLIAM 



BAYIRLI, GUNDUZ 

Dental Lesions in Adult Diabetic Patients. J58-60. 

BERTOLAMI, CHARLES 


JJ58 

BHAGWAT, S.V. 

Clinical Evaluation of Postoperative Sensitivity in 

Composite Resin Restorations Using Various Liners. 

M23-29. 

BIOLOGY AND BEHAVIOR 

Family Matters (Jane A. Weintraub DDS MPH). M14-19. 

BOWMAN, S. JAY 

The Social Six Redux – Is That Really All There Is? (S. Jay 

Bowman DMD MSD). AS42-47. 

BROOME COUNTY 

Substitute Dentists (Betsy Lopez-Abrams). O2. 

BUCHANAN, L. STEPHEN 

The Three Most Common Mistakes in Endodontics 

(L. Stephen Buchanan DDS). O3. 

C 

CALIKKOCAOGLU, SENIH 




of Mandibular Complete Dentures (Pinar Kursolgu 

DDS; Nilgun Ari MSc; Senih Calikkocaoglu DDS Phd). 

AS52-54. 

CANCER 

Mental Nerve Neuropathy as Initial Symptom of Cancer 

(Pia Lopez-Jornet MD PhD). N36-37. 

Reconstruction of Total Maxillectomy Defect With 

Implant-Retained Obturator Prosthesis (Cemal Aydin 

DDS; Ertan Delilbasi DDS; Handan Yilmaz DDS; Secil 

Karakoca DDS; Bilge Turhan Bal DDS). N38-41. 

CARDIOLOGY 



CARROA, VINCENT 


CHABEREK, SLAWOMIR 

Comparison of Efficiency of Platelet Rich Plasma, 

Hematopoieic Stem Cells and Bone Marrow in 

Augmentation of Mandibular Bone Defects. M41-45. 

CHILDREN’S DENTAL HEALTH MONTH 

The Show Must Go On. JJ14-16. 

CHRISTIANSEN, EVAN D. 


CLINICAL DENTISTRY 

End Stage Renal Disease and its Dental Management 

(Dileep C.G. Sharma MDS; A.R. Pradeep MDS). J43-47.


COLUMBIA UNIVERSITY 

A Conversation with Ira Lamster (Elliot M. Moskowitz, DDS). 

A16-19. 

Columbia Dental Assistant Training Program Prepares 

Minority Students for Careers In Community. A53. 

Ralph Kaslick Honored for Career-Long Commitment to 

Scientific and Education Contributions to Dentistry. 

AS69. 

Columbia University College of Dental Medicine Celebrates 

90th Anniversary. O4. 

Researchers Use Adult Stem Cells to Create Soft Tissue. 

AS68. 

Columbia University Dentists Join Millennium Villages 

Project to Improve Oral Health in Sub-Saharan Africa. 

O7. 

CONGENITAL ANOMALY 

Rare but Harmless Jaw Anomaly Can Be Misdiagnosed as 

Serious Condition. J65. 

CONGENITAL DISORDERS 

Congenital Diseases and a New York State Regulation 

(Preet Gupta DDS; Stuart L. Segelnick DDS; 

Milton Palat DDS, JD). JJ20-27. 

CONTINUING EDUCATION 

NYSDA Board Meets in Albany; Alters CE Mandate. J11. 

Association Backs Legislation to Increase Continuing Ed 

Hours and Expand Scope of Practice. MY1. 

New York Setting the Standard for Responsible 

Dentistry(Margaret Surowka Rossi JD). AS6-10. 

CPR 



CROWN AND BRIDGE 

Microleakage of Four Core Materials Under Complete Cast 

Crowns (Zeynep Duymus Yesil DDS, Phd). JJ32-38. 

Crown Preparation in One Hour. (Glen Kreitzberg DDS.) 

N54-56. 

CUBA 

Oral Health in Cuba. (Arthur I. Hazlewood DDS MPH). 

J48-50. 

CUSUMANO, FRANCIS J. 

Empty Glenoid Fossa Sign. J57. 

D 

DELGRANDE, PATRICK A. 

Columbia County Dentist Reappointed to AES Position. J67. 

DENTAL ACCESS 

NYS Dental Foundation and Henry Shein Cares. MY8. 

DENTAL ASSISTING 

What’s an Assistant to Do? (Margaret Surowka Rossi JD). 

M6-8. 

Columbia Dental Assistant Training Program Prepares 

Minority Students for Careers In Community. A53. 

New York Setting the Standard for Responsible Dentistry 

(Margaret Surowka Rossi JD). AS6-10. 

DENTAL BENEFITS 

Why Evidenced-Based Dentistry Matters (Robert S. 

Laurenzano DMD). M10-11. 

DENTAL BONDING 

Effect of Different Services and Surface Applications on 

Bonding Strength of Porcelain Repair Material (Zeynep 

Duymus Yesil DDS Ph.D.; Serpil Karaoglanoglu DDS 

PhD; Nilgun Akgul, DDS PhD; Nur Ozdabak Dr. Med 

Dent; Nurcan Ozakar Ilday Med Dent). A28-32. 

DENTAL CARIES 

Dental Lesions in Adult Diabetic Patients (Mehmet Ilguy; 

Dilhan Ilguy; Gunduz Bayirli). J58-60. 

NYU Dental Researchers Study Twins for Clues As to 

Origin of Caries. J63. 

DENTAL ECONOMICS 

Developments in Dental Economics (H. Barry Waldman 

DDS MPH PhD). MY 5. 

DENTAL EDUCATION 

Managing Your Debt, Managing Your Future. MY4. 

Exporting New Yorkers for Dental Education is a 

Decreasing Option (H. Barry Waldman DDS MPH 

PhD). O8. 

Tracking Newly Licensed Dentists (H.Barry Waldman DDS; 

Mary Rose Truhlar DDS). D14-15. 

DENTAL HUMOR 

Patients from Mars, Patients from Venus. 

(Jeffrey Galler DDS). J96. 

DENTAL INSURANCE 


(Preet Gupta DDS; Stuart L. Segelnick DDS; Milton Palat 

DDS JD). JJ20-27. 

DENTAL MARKETING 

How to Succeed in Dentistry by Really Trying. 

(Glen R. Kreitzberg DDS). D4. 

DENTAL PRACTICE 

Patients from Mars, Patients from Venus 

(Jeffrey Galler DDS). J96. 

Brush up on Your Communication Skills 

(Margaret Surowka Rossi JD). A6-7. 



To Err is Human (Margaret Surowka Rossi JD). MY2. 

DENTAL RESEARCH 

Dental Lesions in Adult Diabetic Patients (Mehmet Ilguy; 




Dental Researchers Test No-Needle Anesthesia, No-Drilling 

Cavity Care. M52. 

April 

May 

June/July 



Practice Based Research Networks (Analia Veitz-Keenan 

DDS; Gary S. Berkowitz DDS; Irene Brandes DDS; 

Kenneth L. Goldberg DMD; David A. Hamlin DMD; 

Robert Margolin DDS; Kay Oen DDS). A14-15. 

Oral Cancer Screening, Dental Needs Assessment and Risk 

Factors Literacy in Hispanic Population in Western New 

York (Yoly M. Gonzalez DDS; Elizabeth B. Lozier BS). 

N32-35. 

DENTAL STATISTICS 

Who Uses and Who Provides Orthodontic Services? 

(H. Barry Waldman DDS MPH PhD). J61-62. 

DENTIST/ATTORNEY RELATIONSHIP 

One Day, You Are Going to Need an Attorney 

(Eric J. Ploumis DMD). N6-9. 

DE STENO, COSMO V. 


Clinical Affairs. D20. 

DIABETES 

Dental Lesions in Adult Diabetic Patients. (Mehmet Ilguy; 


Diabetes and Periodontal Disease – An Example of an 

Oral/System Relationship (Michael A. Perrino). AS38-41. 

DUGONI, ARTHUR A. 




DUSEL, ANDREW 


E 

EDITORIALS (Elliott Moskowitz DDS, MSD) 

Shedding Light on an Invisible Marvel. J4-5. 

Why is the Practice of Dentistry so Challenging, and What 

are the Real Rewards? M4-5. 

Clinical Research in Dentistry. A4. 

Globalization of Dentistry. JJ4. 

Statistics in Dentistry, Who Needs Them? AS4. 

Standard of Care Criteria. N4. 

EDITORIALS (Kevin Hanley, DDS) 

What Price a Healthy Profession? AS4-5. 

EMERGENCY SUPPORT 

When Disaster Strikes (Betsy Lopez-Abrams). O2. 

EMPLOYMENT 


ENDODONTICS 

Clinical and Radiographic Evaluation of Root Perforation 

Repair Using MTA (Jamileh Ghoddusi DDS M.Sc.; 

Azadeh Sanaan DDS; Fatemh Shahrami DDS MSc). 

A46-49. 

The Three Most Common Mistakes in Endodontics (L. 

Stephen Buchanan DDS). O3. 

Endodontic Treatment of Maxillary Central Incisor with 

Two Roots (Jamileh Ghoddusi DDS MSc; Mina Zarei 

DDS MSc; Mehdi Vatanpour DDS). JJ46-47. 

One Man’s Endodontic File Sponge-Armamentarium and 

Rationale (Rich Mounce DDS). JJ54-56. 

Mandibular Canine with Two Separated Canals (Jamileh 

Ghoddusi DDS MSc; Mina Zarei DDS MSc; Mehdi 

Vatampour DDS Sc). N52-53. 

ETHICS 

Getting Creative with Insurance Forms 

(Kevin A. Henner DMD). MY3. 


Do the Right Thing; Ethics-Based Risk Management 

(Chester J. Gary DMD). N10-11. 

Have Practice, Will Advertise (Kevin A. Henner DMD). D3. 

EVIDENCE-BASED DENTISTRY 



Clinical Research in Dentistry (Elliott Moskowitz DDS 

MSc). A4. 

F 

FALLON, MICHAEL W., JR. 

Former NYSDA President Gives Gift to Foundation. J25. 



FELDMAN, MARK 

Mark Feldman Installed ADA President. N24. 

FINANCING 


FLUORIDE 


Foundation Pledges $10,0000 for Fluoridation. A12-13. 

Federal Agency Accepts ADA Recommendations for 

Professionally Applied Topical Fluoride. A53. 

FLYING DENTISTS ASSOCIATION 

Airborne Dentists (Frederick J. Halick DMD). D1-2. 

FOURTH DISTRICT 



Executive Director Retires. J77. 

FOX, EDWARD 

Edward Fox Donates $5 Million to NYU to Establish 

Herman Robert Fox Deanship. AS69. 

G 

GALLER, JEFFREY 

2007 NYSDA President Steven Gounardes. J34-38. 

Patients from Mars, Patients from Venus. J96. 

GEHANI, CHAD 


GENERAL DENTISTRY 


(Dileep C.G. Sharma MDS; A.R. Pradeep MDS). J43-47. 

GENETICS 



GENETIC DISORDERS 


(Kurt Friedman DDS MS; Ines Velez DDS MS). A34-37. 

GIVE KIDS A SMILE 


Award. O6. 

GLEASON, G. KIRK 



GLENOID FOSSA 

Empty Glenoid Fossa Sign. (Kevin J Penna DDS; Richard 

M. Mirra DDS; Francis J. Cusumano DDS). J57. 

GLOBALIZATION 

The Globalization of Dentistry. JJ4. 

GOUNARDES, STEVEN 

2007 NYSDA President Steven Gounardes 

(Jeffrey Galler DDS). J34-38. 


GUEST EDITORIAL 



H 

HAUBEN, DANIEL J. 

Self-Reported Smile Satisfaction – Smile Parameters and 




HAZLEWOOD, ARTHUR I. 

Oral Health in Cuba. J48-50. 

HENNER, KEVIN A. 

Getting Creative with Insurance Forms (Kevin A. Henner 

DMD). MY3. 

Have Practice, Will Advertise (Kevin A. Henner DMD). D3. 

HIV 

NYU College of Dentistry Receives Funding to Study Caries 

in HIV-Positive Women. A50. 

Plunging Ranula in Young HIV Patient. (Adam T. Hershkin 

DMD; Edward J. Miller Jr. DMD). N46-47. 

HOEXTER, DAVID L. 

Melkerson Rosenthal Syndrome. M30-32. 

HOROWITZ, ALICE 

Second Annual Foundations of Excellence Awards. 

J24-25. 



HYGIENE 

Children’s Fingernail Hygiene and Length as Predictors of 

Carious Teeth. (Charles D. Larsen DMD MS; Elena 

Staviky DMD; Michael D. Larsen PhD; Michael S. 

Rosenbaum DMD). M33-37. 

HYPERPLASTIC LESIONS 

Xanthomatous Changes in Case Provisionally Diagnosed as 

Fibroma (Dileep Sharma CG MDS; A.R. Pradeep MDS). 

AS61-63. 

I 

IACONO, VINCENT J. 

Stony Brook Professor Honored. N60. 

ILGUY, DILHAN 


ILGUY, MEHMET 


IMPACTED TEETH 

Laser Exposure of Unerupted Teeth (Ali Asgari DDS; Barry 

L. Jacobson DMD; Manisha Mehta DMD; John L. Pfail 

DDS). A38-41. 

IMPLANTOLOGY 


Surgical Guidance (Dov M. Almog DMD; Paul R. 

Romano DDS MS). J51-53. 



Augmentation of Mandibular Bone Defects (Andrzej 

Wojtowicz; Slawomir Chaberek; Elzbieta Urbanowska; 

Kazimierz Ostrowski). M41-45. 

Anterior Maxillary Resin-Bonded Fixed Partial Denture to 

Preserve Occlusal Surface Area for Anterior Guidance 

(Hiroshi Shimizu DDS PhD; Yutaka Takahashi DDS 

PhD). JJ28-30. 

INFECTIVE ENDOCARDITIS (IE) 



INSURANCE 

Getting Creative with Insurance Forms (Kevin A. Henner 

DMD). MY3. 

J 

JARVIE-BURKHART 


JEFFRIES, JOCELYN 


JOSEPHS, PHILLIP K. 

Columbia Senior Honored for Developing Minority 

Recruitment Program. D16. 

K 

KARABIN, SUSAN 

New York Periodontist to Head Academy. N60. 

KASLICK RALPH 

Ralph Kaslick Honored for Career-Long Commitment to 

Scientific and Education Contributions to Dentistry. 

AS69. 

KAURANI, MAYANK 


Composite Resin Restorations Using Various Liners. 

M23-29. 

KERPEL, STANLEY M. 

Klippel-Trenaunay Syndrome – Report of Case Affecting 

Oral Cavity (Stanley M. Kerpel DDS). AS64-66. 

KLEMPNER, LEON S. 


KLIPPEL-TRENAUNAY SYNDROME 

Klippel-Trenaunay Syndrome – Report of Case Affecting 


KUMAR, JAYANTH V. 

State Health Official Receives ADA Council Award. J67. 

KURSOGLU, PINAR 






AS52-54. 

L 

LAMSTER 

A Conversation with Ira Lamster (Elliot Moskowitz DDS 

MSc). A16-19. 

LARSEN, CHARLES 


Carious Teeth. M33-37. 

LARSEN, MICHAEL 



LASER TREATMENT 

Laser Exposure of Unerupted Teeth (Ali Asgari DDS; Barry 

L. Jacobson DMD; Manisha Mehta DMD; John L. Pfail 

DDS). A38-41. 

LAURENZANO, ROBERT S. 

Why Evidenced-Based Dentistry Matters.M10-11. 

LEARY, PAUL 


LEE, HEEJE 


LEGAL 

Retiring, Selling or Closing Your Practice (Margaret 

Surowka Rossi JD). J6-7. 

What’s an Assistant to Do? (Margaret Surowka Rossi JD). 

M6-8. 

Brush up on Your Communication Skills (Margaret 

Surowka Rossi JD). A6-7. 


Prescription for Passing Inspection (Margaret Surowka 

Rossi JD). JJ6-7. 

New York Setting the Standard for Responsible Dentistry 

(Margaret Surowka Rossi JD). AS6-10. 

One Day, You Are Going to Need an Attorney (Eric J. 

Ploumis DMD). N6-9. 

LEGISLATION 

NYSDA Enjoys Several Legislative Victories. AS15. 



Tracking Newly Licensed Dentists (H.Barry Waldman DDS; 

Mary Rose Truhlar DDS). D14-15. 

LEVIN, LIRAN 





LIN, SYLVIA SHIHPIN 


LOPEZ-ABRAMS, BESTY 

When Disaster Strikes. O2. 

M 

MALAMUD, DANIEL 


MANDEL, LOUIS 

Parotid Stone Removal. J54-56. 

MC GIVERN, BERNARD E. JR. 

From Chairside to Ringside. O14. 

MEHRA, PRAVESH 

Complex Composite Odontoma Associated with Impacted 

Tooth. M38-40. 

MELKERSON ROSENTHAL SYNDROME 

Melkerson Rosenthal Syndrome (David L. Hoexter DMD). 

M30-32. 

MENTAL NERVE NEUROPATHY 

Mental Nerve Neuropathy as Initial Symptom of Cancer. 

(Pia Lopez-Jornet MD PhD). N36-37. 

MESHULAM-DERAZON, SAGIT 





MINERAL TRIOXIDE AGGREGATE 


Repair Using MTA (Jamileh Ghoddusi DDS MSc; 


A46-49. 



August/September 

October 

November 


MIRRA, RICHARD M. 


MOSKOWITZ, ELLIOTT 

Shedding Light on an Invisible Marvel. J4-5. 

Why is the Practice of Dentistry so Challenging, and What 

are the Real Rewards? M4-5. 

A Conversation with Ira Lamster. A16-19. 

Statistics in Dentistry, Who Needs Them? AS4. 


N 

NASH, SEYMOUR 

Organized Dentistry in New York State Mourns Death of it 

“Father.” AS14. 

NEUROLOGICAL DISORDER 

Melkerson Rosenthal Syndrome (David L. Hoexter DMD). 

M30-32. 

NINTH DISTRICT 

Association Elects First Woman President. J68. 

When Disaster Strikes. O2. 

NYSDA 

Revisions to NYSDA Bylaws Proposed. J9. 


2007 NYSDA President Steven Gounardes (Jeffrey Galler 

DDS). J34-38. 


Association’s Top Awards. MY1 


The Show Must Go On. JJ14-16. 


“Father.” AS14. 

NYSDA Enjoys Several Legislative Victories. AS15. 

NYSDA Peer Assistance Coordinator Honored for Years of 

Helping Dentists in Trouble. O12. 

Sugarless Wednesday Program Receives ADA Golden 

Apple. O20. 


NYS DENTAL FOUNDATION 


Former NYSDA President Gives Gift to Foundation. J25. 

Foundation to Recognize Graduating Dentists. A5 

Foundation Pledges $10,000 for Fluoridation. A12-13 

NYS Dental Foundation and Henry Schein Cares. MY8. 



Award. O6. 

Two Organizations Rewarded by Dental Foundation/Henry 

Schein Cares Partnership. N26. 

NYU 



NYU Dental College Receives Funding for Cigarette Study. 

J64. 


NYU College of Dentistry Receives Funding to Study 

Caries in HIV-Positive Women. A50. 


JJ58. 

Edward Fox Donates $5 Million to NYU to Establish 

Herman Robert Fox Deanship. AS69. 




NYU College of Dentistry/School of Medicine Partner with 

UMDNJ to Study Causes of Temporomandibular 

Disorder. N59. 

New Master’s Program Combines Biology and Oral 

Biology. D10. 


Clinical Affairs. D20. 

O 

OBITUARIES 



“Father.”AS14. 

Thomas Sullivan Dies; Long Time Advocate for Troubled 

Dentists. D8. 

O’CONNOR, MICHAEL P. 


ODONTOMAS 


Tooth (Pravesh Mehra MDS; Harmeet Singh BDS). 

M38-40. 

Unusually Large Complex Odontoma in Maxillary Sinus 

Associated with Unerupted Tooth (Steven R. Singer 

DDS; Muralidhar Mupparapu DMD MDS; Maano 

Milles DDS; Joseph Rinaggio DDS MS; Dominic Pisano 

DMD; Patrick Quaranta DMD). JJ51-53. 

ORAL CANCER 


Factors Literacy in Hispanic Population in Western 

New York (Yoly M. Gonzalez DDS; Elizabeth B. Lozier 

BS). N32-35. 

ORAL DIAGNOSIS 

Early Manifstation of Pemphigus Vulgaris (Keith Da Silva; 

Louis Mandel DDS). A42-44. 

ORAL HEALTH 





ORAL LESIONS 

Early Manifestation of Pemphigus Vulgaris (Keith Da 

Silva; Louis Mandel DDS). A42-44. 

ORAL PIERCING 

Alveolar Bone Loss and Gingival Recession Due to Lip and 

Tongue Piercing (Liran Levin DMD). JJ48-50. 

ORAL SURGERY 

Parotid Stone Removal (Mimi J.Y. Park DDS; Louis Mandel 

DDS). J54-56. 


Tooth (Pravesh Mehra MDS; Harmeet Singh BDS). 

M38-40.




Augmentation of Mandibular Bone Defects. (Andrzej 



Oral Surgeons Would Benefit. MY1. 

Unusually Large Complex Odontoma in Maxillary Sinus 

Associated with Unerupted Tooth (Steven R. Singer 

DDS; Muralidhar Mupparapu DMD MDS; Maano 

Milles DDS; Joseph Rinaggio DDS MS; Dominic Pisano 

DMD; Patrick Quaranta, DMD). JJ51-53. 

Xanthomatous Changes in Case Provisionally Diagnosed 

as Fibroma (Dileep Sharma CG MDS; A.R. Pradeep 

MDS). AS61-63. 


Implant-Retained Obturator Prosthesis (Cemal Aydin 

DDS; Ertan Delilbasi DDS; Handan Yilmaz, DDS; Secil 


ORTHODONTICS 

Who Uses and Who Provides Orthodontic Services? 

(H. Barry Waldman DDS MPH PhD). J61-62. 


Incisor. (Howard M. Tichler DDS MScD; Jenny E. 

Abraham DDS). M20-22. 





OSTROWSKI, KAZIMIERZ 




P 

PARK, MIMI J.Y. 

Parotid Stone Removal. J54-56. 

PAROTID STONE 


DDS). J54-56. 

PEDIATRIC DENTISTRY 





A Role for the Family In Children’s Oral Health (Keith 

DaSilva). AS 55-57. 

PEMPHIGUS VULGARIS 

Early Manifstation of Pemphigus Vulgaris (Keith Da Silva; 

Louis Mandel DDS). A42-44. 

PENNA, KEVIN J. 


PERCY T. PHILLIPS VISITING PROFESSOR PROGRAM 

Dental Educator Selected to Deliver P.T. Phillips Lecture. 

AS 15. 



A Role for the Family In Children’s Oral Health (Keith 

DaSilva). AS 55-57. 

PERIODONTOLOGY/PERIODONTAL 

DISEASE/PERIODONTICS 

Reevaluation of Initial Therapy (Stuart L. Segelnick DDS; 

Mea A. Weinberg DMD). M46-49. 

Secondhand Smoke May Cause Bone Loss in People with 

Periodontitis. MY2. 







MDS). AS61-63. 

PERSPECTIVES 

Practice-Based Research Networks. A14-15. 

PERRINO, MICHAEL A. 



PHILLIPS, PERCY T. 

Family Matters (Jane A. Weintraub DDS MPH). M14-19. 

PHOTODYNAMIC THERAPY 



PIERRE FAUCHARD ACADEMY 


PLOUMIS, ERIC J. 

One Day, You Are Going to Need an Attorney (Eric J. 

Ploumis DMD).N6-9. 

PLUNGING RANULA 

Plunging Ranula in Young HIV Patient (Adam T. Hershkin 

DMD; Edward J. Miller Jr. DMD). N46-47. 

POLLAN, LEE 

Rochester Surgeon Installed President American OMS 

Association. N59. 

POST AND CORE 

Successful Post and Core Buildup (Eugene Joffe DDS). 

N42-44. 

PRACTICE MANAGEMENT 

The Three Most Common Mistakes in Endodontics (L. 

Stephen Buchanan DDS). O3. 



Putting an End To Cancellations and No-Shows (Lois 

Banta). D5. 

PRACTICE BASED RESEARCH 

Clinical Research in Dentistry (Elliott Moskowitz DDS 

MSc). A4. 

December 

Practice Based Research Networks (Analia Veitz-Keenan 

DDS; Gary S. Berkowitz DDS; Irene Brandes DDS; 

Kenneth L. Goldberg DMD; David A. Hamlin DMD; 

Robert Margolin DDS; Kay Oen DDS). A14-15. 

PRADEEP, A.R. 

End Stage Renal Disease and its Dental Management. J43-47. 



MDS). AS61-63. 

PRESCRIPTIONS 

Prescription for Passing Inspection (Margaret Surowka 

Ross JD). JJ6-7. 

PROBLEM PATEINT 

To Err is Human. (Margaret Surowka Rossi JD). MY2. 

PROSTHETICS 


of Mandibular Complete Dentures. (Pinar Kursolgu 

DDS; Nilgun Ari MSc; Senih Calikkocaoglu DDS Phd.) 

AS52-54. 

Preparation for Posterior Partial Veneered Restoration to 

Maintain Vertical Dimension of Occlusion (Hiroshi 

Shimizu DDS Phd; Yutaka Takahashi DDS PhD).AS58-60. 

PROSTHODONTICS 


Technique (Pinar Kursoglu DDS PhD; Nilgun Ari MSc; 

Senih Calikkocaoglu DDS PhD). J40-42. 

Simplified Method for Recording Maxillomandibular 

Relations in Complete Dentures (Paul J. Boulos DDS). 

A24-27 


Implant-Retained Obturator Prosthesis (Cema Aydin 

DDS; Ertan Delilbais DDS; Handan Yilmaz DDS; Secl 




Q 

QUEENS COUNTY 



R 

RADIOGRAPHY 


Surgical Guidance (Dov M. Almog DMD; Paul R. 

Romano DDS MS). J51-53. 

Empty Glenoid Fossa Sign (Kevin J. Penna DDS; Richard 

M. Mirra DDS; Francis J. Cusumano DDS). J57. 

Dental X-Rays of Carotid Artery Not Enough to Estimate 

Stroke Risk. MY9. 




AS52-54. 

RAMANO, PAUL R. 


Surgical Guidance. J51-53. 

RECORDKEEPING 


RECRUITMENT 

Columbia Senior Honored for Developing Minority 

Recruitment Program. D16. 

REGULATIONS 


(Preet Gupta DDS; Stuart L. Segelnick DDS; Milton 

Palat DDS, JD). JJ20-27. 

RENAL DISEASE 


(Dileep C.G. Sharma MDS; A.R. Pradeep MDS). J43-47. 

RENAL FAILURE 


(Kurt Friedman DDS, MS; Ines Velez DDS MS). A34-37. 

RESEARCH 

Secondhand Smoke May Cause Bone Loss in People with 

Periodontitis. MY2. 

Researchers Use Adult Stem Cells to Create Soft Tissue.AS68. 

RESIN-BONDED PROSTHESIS 




RESTORATIVE DENTISTRY 


Incisor (Howard M. Tichler DDS MScD; Jenny E. 

Abraham DDS). M20-22. 


Composite Resin Restorations Using Various Liners 

(Mayank Kaurani BDS MDS; S.V. Bhagwat BDS MDS). 

M23-29. 

RETIREMENT 



RISK MANAGEMENT 



ROOT PERFORATION 


Repair Using MTA (Jamileh Ghoddusi DDS MSc; 


A46-49. 

ROSENBAUM, MICHAEL S. 



ROSSI, MARGAGET SUROWKA 

Retiring, Selling or Closing Your Practice. J6-7. 

What’s an Assistant to Do? M6-8. 

Brush up on Your Communication Skills. A6-7. 

To Err is Human. MY2. 

Prescription for Passing Inspection. JJ6-7. 

New York Setting the Standard for Responsible Dentistry. 

AS6-10. 

S 

SALIERNO, CHRISTOPHER 


SALIVARY GLAND DISORDER 


DDS). J54-56. 

SCHEIN, HENRY 

NYS Dental Foundation and Henry Shein Cares. MY8. 

SCHORK, ANTHONY M. 

Statistics by Zooth - A Primer (M. Anthony Schork Phd). 

AS30-37. 

SCOPE OF PRACTICE 

Oral Surgeons Would Benefit. MY1. 

SEGELNICK, STUART L. 

Reevaluation of Initial Therapy. M46-49. 

SEIDBERG, BRUCE H. 

Fifth District Endodontist President College Legal 

Medicine. D6. 

SHARMA, DILEEP C.G. 

End Stage Renal Disease and its Dental Management. J43-47. 



MDS). AS61-63. 

SHIMIZU HIROSHI 




SHIP, JONATHAN A. 

NYU Professor Honored. JJ60 

SINGH, HARMEET 


Tooth. M38-40. 

SMILE PARAMETERS 





SMITH, DAVID 


SMOKING CESSATION 

UB Students Help Patients Quit Smoking. A51. 

STAFNE’S MANDIBULAR DEFECT 




AS52-54. 

STATISTICS 

Statistics by Zooth - A Primer (M. Anthony Schork Phd). 

AS30-37. 

Buyer Beware (Marvin J. Schissel DDS). N16-17. 

STANDARD OF CARE 


Why CT Scans are Already the Standard of Care (Alan A. 

Winter DDS). N28-30. 

STAVISKY, ELENA 



STEM CELLS 

Researchers Use Adult Stem Cells to Create Soft Tissue. 

AS68. 

STROKE 

Dental X-Rays of Carotid Artery Not Enough to Estimate 

Stroke Risk. MY9. 

STUDENT LOANS 


SUDZINA, MICHAEL 


SULLIVAN, THOMAS 

NYSDA Peer Assistance Coordinator Honored for Years of 

Helping Dentists in Trouble. O12. 

Thomas Sullivan Dies; Long Time Advocate for Troubled 

Dentists. D8. 



T 

TAKAHASHI YUTAKA 




TEMPOROMANDIBULAR DISORDER 

NYU College of Dentistry/School of Medicine Partner with 

UMDNJ to Study Causes of Temporomandibular 

Disorder. N59. 

THEODOROU, PETER J., D.M.D. 


THERAPY REEVALUATION 

Reevaluation of Initial Therapy (Stuart L. Segelnick DDS; 

Mea A. Weinberg DMD). M46-49. 

TICHLER, HOWARD M. 


Incisor. M20-22. 

TILLIS AWARD 


TISSUE AUGMENTATION 



Augmentation of Mandibular Bone Defects. (Andrzej 



TOBACCO 

NYU Dental College Receives Funding for Cigarette Study. J64. 

TOOTHBRUSHES 

Bacterial Contamination and Decontamination of 

Toothbrushes after Use (Abhishek Mehta BDS; Peter 

Simon Sequeira MDS; Gopalkrishna Bhat PhD). A20-21. 

TREATMENT PLANNING 


TUBERCULOSIS 

Atypical Presentation of Oral Tuberculosis Ulcer (Sumita 

Mahajan MDS; Natarajan Srikant MDS; Thomas 

George MDS). N48-50. 

U 

UMDNJ DENTAL SCHOOL 

UMDNJ Dental School in Cooperative Program to Treat 

People with Addictions. J66. 

UNIVERSITY AT BUFFALO 

Rare but Harmless Jaw Anomaly Can Be Misdiagnosed as 

Serious Condition. J65. 

Dental Researchers Test No-Needle Anesthesia, No- 

Drilling Cavity Care. M52. 

UB Students Help Patients Quit Smoking. A51 


Factors Literacy in Hispanic Population in Western 

New York (Yoly M. Gonzalez DDS; Elizabeth B. Lozier 

BS). N32-35. 

URBANOWSKA, ELZBIETA 




V 

VALACHOVIC, RICHARD 

Dental Educator Selected to Deliver P.T. Phillips Lecture. 

AS 15. 

VASCULAR DISORDERS 

Klippel-Trenaunay Syndrome- Report of Case Affecting 


VENEERS 

Effect of Different Services and Surface Applications on 

Bonding Strength of Porcelain Repair Material 

(Zeynep Duymus Yesil DDS PhD; Serpil Karaoglanoglu 

DDS PhD; Nilgun Akgul DDS PhD; Nur Ozdabak Dr 

Med Dent; Nurcan Ozakar Ilday Med Dent). A28-32. 

VIEWPOINT 



Buyer Beware (Marvin J. Schissel DDS). N16-17. 

VOLUNTEERISM 

Columbia University Dentists Join Millennium Villages 

Project to Improve Oral Health in Sub-Saharan Africa. O7. 

The Dental Volunteer Abroad (Arthur I. Hazlewood DDS). 

D12-13. 

Airborne Dentists (Frederick J. Halick DDS). D1. 

W 

WALDMAN, H. BARRY 

Who Uses and Who Provides Orthodontic Services? J61-62. 

Developments in Dental Economics (H. Barry Waldman 

DDS MPH PhD). MY5. 

Exporting New Yorkers for Dental Education is a 

Decreasing Option (H. Barry Waldman DDS MPH 

PhD). O8. 

WESTCOTT, ROBERT 

Executive Director Retires. J77. 

WEINBERG, MEA A. 

Reevaluation of Initial Therapy. M46-49. 

WEINTRAUB, JANE A. 

Family Matters. M14-19. 

WINTER, ALAN A. 

Why CT Scans are Already the Standard of Care (Alan A. 

Winter DDS). N28-30. 

WOJTOWICZ, ANDRZEJ 

Comparison of Efficiency of Platelet Rich Plazma, 



WYNN, LAURENCE A. 


Z 

ZHANG, YU 



BOOK REVIEWS 

“Oral & Intravenous Bisphosphonate-Induced 

Osteonecrosis of the Jaws” (Robert E. Marx DDS). 

Reviewed by Leonard B. Goldstein DDS PhD. M70. 

“Treatment Planning in Dentistry” (Stephen J. Stefanac 

DDS MS; Samuel Paul Nesbit DDS MD). Reviewed by 

Theodore J. Klopman DDS MPA. M71. 

“A Dental Treasure Chest” (Wolfram Bucking). Reviewed 

by Kevin J. Hanley DDS. M71. 

“Atlas of Laser Applications in Dentistry” (Donald J. 

Coluzzi DDS; Robert A. Convissar DDS). Reviewed by 

Lawrence Wolfgang DDS. M73. 

“Surgical Manual of Implant Dentistry: Step-by-Step 

Prodcedures” (Daniel Busser DDS; Dr Med Dent; Jun- 

Young Cho DDS; Alvin B.K. Yeo BDS MSc). Reviewed by 

Michael J. Garvey DMD. A63 

“Implant Therapy in the Esthetic Zone: Single-Tooth 

Replacements” (Daniel Busser; Urs Belser; Daniel 

Wismeijer). Reviewed by Benjamin P. Graham DMD.A64. 

“Baltimore’s Own: The World’s First Dental School, 1840-2006” 

(John M. Hyson, Jr). Reviewed by Malvin E. Ring DDS.A64. 

“A Clinical Guide to Dental Traumatology” (Louis H. 

Berman; Lucia Blanco; Stephen Cohen). Reviewed by 

Neal R. Levitt DDS. JJ74. 

“Craniomaxillofacial Reconstructive and Corrective Bone 

Surgery; Principles of Internal Fixation Using the 

AO/ASIF Technique” (Alex M. Greengerg; Joachim 

Prein). Reviewed by Stuart Super DMD; Marci Levine 

MD, DMD). JJ74. 

“Tooth Whitening – Indications and Outcomes of 

Nightguard Vital Bleaching” (Van B. Haywood DMD). 

Reviewed by Theodore J. Klopman DDS MPA. AS80. 

“The Power of Ultrasonics” (Fridus van der Weijden). 

Reviewed by Michael R. Breault DDS. N73. 

“Contemporary Orthodontics, 4th Edition.” (William R. 

Proffit; Henry W. Fields Jr.; David M. Sarver). Reviewed 

by Rekha C. Gehani. N73. 

“Minimally Invasive Dentistry: The Management of 

Caries” (Narilh H. F. Wilson). Reviewed by Leonard B. 

Goldstein DDS. N74-75. 

“Appplications of Orthodontic Mini-Implants” (Jong Suk 

Lee, DDS; Jung Kook Kim DDS; Young-Chel Park DDS; 

Robert L. Vanarsdall Jr DDS). Reviewed by Benjamin P. 

Graham DMD. N75-76.

Organizational Unity - New York State Dental Association

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