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Tạp chí chỉnh hình OPUS tháng 5 6 2013 vol 4 no3
3D imaging for lower dose than a 2D panoramic * is not magic… it’s Learn more on page *Data on file. PAYING SUBSCRIBERS EARN 24 CONTINUING EDUCATION CREDITS PER YEAR! s • technology reviews May/June 2013 – Vol 4 No 3 P R O M O T I N G E X C E L L E N C E I N O R T H O D O N T I C S Incorporating TAD- supported Haas expansion into everyday practice Drs. Ryan K. Tamburrino and Shalin R. Shah Corporate profile Ormco A new regimen of Phase I care applied to potential maxillary canine impactions Dr. John Hayes • Practice profile Dr. Mark Reynolds BioDigital Orthodontics: Diagnopeutics with SureSmile technology: part 3 Dr. Rohit C.L. Sachdeva 49 Volume 4 Number 3 Orthodontic practice 1 May/June 2013 - Volume 4 Number 3 EDITORIAL ADVISORS Lisa Alvetro, DDS, MSD Daniel Bills, DMD, MS Robert E. Binder, DMD S. Jay Bowman, DMD, MSD Stanley Braun, DDS, MME, FACD Gary P. Brigham, DDS, MSD George J. Cisneros, DMD, MMSc Jason B. Cope, DDS, PhD Neil Counihan, BDS, CERT Orth Eric R. Gheewalla, DMD, BS Dan Grauer, DDS, Morth, MS Mark G. Hans, DDS, MSD William (Bill) Harrell, Jr, DMD John L. Hayes, DMD, MBA Paul Humber, BDS, LDS RCS, DipMCS Laurence Jerrold, DDS, JD, ABO Chung H. Kau, BDS, MScD, MBA, PhD, MOrth, FDS, FFD, FAMS Marc S. Lemchen, DDS Edward Y. Lin, DDS, MS Thomas J. Marcel, DDS Andrew McCance, BDS, PhD, MSc, FDSRCPS, MOrth RCS, DOrth RCS Mark W. McDonough, DMD Randall C. Moles, DDS, MS Elliott M. Moskowitz, DDS, MSd, CDE Atif Qureshi, BDS Rohit C.L. Sachdeva, BDS, M.dentSc Gerald S. Samson, DDS Margherita Santoro, DDS Shalin R. Shah, DMD (Abstract Editor) Lou Shuman, DMD, CAGS Scott A. Soderquist, DDS, MS Robert L. Vanarsdall, Jr, DDS John Voudouris (Hon) DDS, DOrth, MScD Neil M. Warshawsky, DDS, MS, PC John White, DDS, MSD Larry W. White, DDS, MSD, FACD PUBLISHER Lisa Moler Email: lmoler@medmarkaz.com Tel: (480) 403-1505 MANAGING EDITOR Mali Schantz-Feld Email: mali@medmarkaz.com Tel: (727) 515-5118 ASSISTANT EDITOR Kay Harwell Fernández Email: kay@medmarkaz.com PRODUCTION MANAGER/CLIENT RELATIONS Kim Murphy Email: kmurphy@medmarkaz.com NATIONAL SALES/MARKETING MANAGER Drew Thornley Email: drew@medmarkaz.com Tel: (619) 459-9595 NATIONAL SALES REPRESENTATIVE Sharon Conti Email: sharon@medmarkaz.com Tel: (724) 496-6820 E-MEDIA MANAGER/GRAPHIC DESIGN Greg McGuire Email: greg@medmarkaz.com PRODUCTION ASST./SUBSCRIPTION COORDINATOR Lauren Peyton Email: lauren@medmarkaz.com MedMark, LLC 15720 N. Greenway-Hayden Loop #9 Scottsdale, AZ 85260 Tel: (480) 621-8955 Fax: (480) 629-4002 Toll-free: (866) 579-9496 Web: www.orthopracticeus.com SUBSCRIPTION RATES Individual subscription 1 year (6 issues) $99 3 years (18 issues) $239 © FMC 2013. All rights reserved. FMC is part of the specialist publishing group Springer Science+Business Media. The publisher’s written consent must be obtained before any part of this publication may be reproduced in any form whatsoever, including photocopies and information retrieval systems. While every care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information printed herein, or in any consequence arising from it. The views expressed herein are those of the author(s) and not necessarily the opinion of either Orthodontic Practice US or the publisher. T hose of you who know me, or have heard me lecture, know that I have been a lifelong student of orthodontics. The goal to continually improve treatment techniques and final results is what keeps me excited and passionate about our wonderful profession. In fact, I can honestly say that in the past few months, I have worked harder than ever critically evaluating not only where we have been over the past 20 years but carefully analyzing where we need to go to keep improving the Damon System. In February 2013, it was very gratifying to host the 12th Annual Damon Forum in Orlando, which has become the largest privately sponsored orthodontic event in the world. The take-away from my presentation and others was encouraging clinicians to 1) keep it simple by utilizing “torquing couples” in each bracket/archwire interface that gives the clinician true straightwire with three-dimensional control, 2) focus on improving the quality of final results, and 3) to truly have fun. The significance of selecting “torquing couples” on each anterior tooth allows the clinician to gain first, second, and third order control with improved force management, increased patient comfort, and in many situations decrease treatment time for the patient. Today, we all live in a very complicated and busy world. I encourage clinicians to strive to have more fun running their businesses through improved clinical efficiencies and effectiveness. As a profession, we have often evaluated clinical proficiency based on final tooth position and how teeth fit together. Often we hear the comment, “show me the plaster on the table.” With technologies available today, I strongly encourage clinicians to also include treatment planning, clinical case management, and impact on bone and tissue during and after treatment when critically evaluating clinical proficiency. Simply put: straight teeth should not come at a long-term high cost to the periodontium. For highest quality results, clinicians must keep abreast of today’s latest technologies. Unfortunately, it is often human nature to resist and fall into the trap of saying that you are for progress but in reality fear change! My advice: don’t let fear hold you back from cutting-edge treatment mechanics. With the right education, training, mentors, and a proper treatment planning, you can enhance the quality of your patient results while minimizing stress on your clinical life. Lastly, set a goal to have more fun running your business in 2013. It is so much more enjoyable for everyone to be part of a practice and business that strives to create a special, positive environment for patients and staff. The energy and excitement you convey to your patients will have a positive impact on their desire to come in for appointments and also to refer other potential patients. Worldwide, I have observed that happy and energetic offices are usually very busy. I have always been impressed with orthodontists who have passion to continue improving. As you strive to make your practice more successful, continue to expand your knowledge, inspire growth within your staff, and diligently work towards better and better final results. Remember: keep it simple. Focus on quality results. Have fun! Dwight Damon, DDS, MSD, developer of the Damon System, is an industry-leading orthodontist with an office in Spokane, Washington. Widely known for his development of the Damon System — a passive self-ligation braces system that allows for low-friction, low-force orthodontic treatment — Dr. Damon is a pioneer in the field whose passion has been to improve orthodontic patient care worldwide. Dr. Damon has received numerous awards and professional honors including the 2009 Washington State University Regents’ Distinguished Alumnus Award, the highest honor the university confers upon its alumni. He was also elected as a Fellow of the Royal Society of Surgeons of Edinburgh. www.damon-smiles.com. INTRODUCTION Forever a student of orthodontics TABLE OF CONTENTS Practice profile Dr. Mark Reynolds: Empowering patients through smiles A focus on patients, family, and continuous learning keeps this orthodontist fulfilled and content 6 Corporate profile Ormco. Your Practice. Our Priority. This leading manufacturer and provider of orthodontic technology and services is dedicated to supporting orthodontic practices in an ever-changing and competitive environment 8 Clinical Dentomandibular sensorimotor dysfunction: what it is and how providing care can benefit orthodontic practices and their patients Dr. Ronald Cohen explores a systematic approach to a painful disorder of the head and neck before orthodontic therapy 10 2 Orthodontic practice Volume 4 Number 3 Case study Orthodontic technology case report: three-dimensional lingual treatment in combination with a temporary anchorage device (TAD) Dr. Edward Lin treats a case to resolve crowding, straighten teeth, and improve the smile 16 Orthodontic concepts BioDigital Orthodontics: Diagnopeutics with SureSmile technology: part 3 Dr. Rohit C.L. Sachdeva explains his approach to designing a personalized therapeutic solution .22 Everywhere your practice needs to be Our CS OrthoTrac Cloud is a powerful practice management and imaging solution that makes data security simple and virtually worry-free. Access it any time, from any location using any computer or tablet device. • Greater exibility with offsite and HIPAA-compliant storage, always equipped with the latest software • The best of OrthoTrac software with the benets of a cloud environment • Ideal for single or multi-location practices with wireless Internet access via computer, tablet or iPad ® • Minimal upfront cost with simple monthly installments Call 800.944.6365 or explore it here carestreamdental.com/cscloud Virtually everywhere CS OrthoTrac Cloud © Carestream Health, Inc. 2013. OrthoTrac is a trademark of Carestream Health. iPad is a trademark of Apple, Inc., registered in the US and other countries. 8999 OR OT AD 0513 8999 Ortho Practice ad.indd 1 4/23/13 10:39 AM 4 Orthodontic practice Volume 4 Number 3 Continuing education Incorporating TAD-supported Haas expansion into everyday practice Drs. Ryan K. Tamburrino and Shalin R. Shah explore appliance design, delivery technique, and expansion protocols as it relates to the TAD- supported Haas .32 Complete Clinical Orthodontics: treatment mechanics: part 3 Dr. Antonino Secchi summarizes the specific strategies within the CCO System to manage space closure in different anchorage situations 38 Research A new regimen of Phase I care applied to potential maxillary canine impactions Dr. John Hayes outlines a study of canine impactions to evaluate a regimen of Phase I care 44 Banding together Hector’s story Dr. Mark Reynolds tells about the many people involved in bringing this novel case to its happy conclusion .52 Education exploration GCARE webinars: inspiration, exploration, and education: part 4 A new webinar program, GAC Clinical Alliance for Research and Education (GCARE), pertains to all stages of the orthodontic community, from residents to practicing orthodontists .54 “Tech”-nique Accelerated orthodontics through micro-osteoperforation Dr. Jonathan L. Nicozisis explains a new micro-invasive technique 56 Product profile Esprit Class II corrector .58 Step-by-step Reliance Orthodontics: Perfect A Smile ™ pontic paint An elegant solution to a unique problem with clear aligners 60 Book review Orthodontic Pearls: A Clinician’s Guide By Larry W. White, DDS, MSD 61 Practice management Overcoming technology bottlenecks Toby Buckalew discusses how new technology can steer a practice in the right direction and speed up performance .62 Materials & equipment 64 TAD-supported Haas expansion 32 TABLE OF CONTENTS Where Practice Growth Takes Root With an ever-expanding base of benets for our members, the UOBG is constantly evolving to keep our members ahead of whatever the economy has in store. In the past 12 months alone, we’ve added: The Progressive Orthodontist The Progressive Dentist* (Subscriptions FREE with coupon) Access to Pride Institute Practice Management Solutions Money Saving Benets of GACPowered Practice Marketing The only thing that hasn’t changed is the price, which remains FREE! Who Can You Trust to Help Grow Your Practice? Come see what you’ve been missing. www.UOBG.org 800.645.5530 *Subscription FREE with coupon for referring practices. In addition to member-only discounts, a complimentary CE course and access to the UOBG Preferred Partner Program, members earn valuable coupon points to redeem for FREE products and practice building opportunities! Join over 3,000 orthodontists and start saving on products you already use by becoming a UOBG member. What can you tell us about your background? I grew up in Northwest Ohio in the small village of Bluffton. It is a quaint little college town in a rural, country setting. Like many others in the area, my father worked for Ford’s engine plant in nearby Lima. Early on, I took on jobs in the service sector: mowing lawns, working in an ice cream parlor, and helping to manage a restaurant. After high school, I attended Ohio State University where I was sure that I was destined to be a certified public accountant. (I eventually made my way to the University of Maryland for dental school.) Why did you decide to focus on orthodontics? After some really crazy overtime as a CPA, I decided that I needed a career change. I realized that what I missed was the personal interactions that I used to have with my regular customers at the restaurant. I looked around for what would give me that kind of interaction again and settled on dentistry. Two years into my dental program, I was approached by one of my orthodontic professors who thought I had potential as an orthodontist. Fortunately, we had a fourth year mini- residency program at school that allowed me to take on some active cases. It was just what I had been missing, and I was hooked. How long have you been practicing, and what systems do you use? I am in my tenth year of private practice. We use Insignia ™ , the Damon ® System and Invisalign ® . What training have you undertaken? Training began in my mini-residency at the University of Maryland, Baltimore. After graduation, I completed an AEGD residency at the Lancaster Cleft Palate Clinic with a great exposure to different craniofacial disorders and the changes those disorders have on normal facial development. I selected my orthodontic residency at the University of Texas, Houston due to its research program as well as its relationship with the oral surgery department. This well- established interdepartmental relationship allowed me to continue to be exposed to a wide range of skeletal malocclusions as well as some unique craniofacial disorders. Since graduation, I have continued to learn more about occlusion and facial development from The Dawson Academy, Dr. Jeffery Okeson, the Damon Forum, and recently the Academy of Clinical Sleep Disorder Disciplines. What is the most satisfying aspect of your practice? Everyone lives for that first time a patient sees his/her teeth at debond and then can’t stop smiling. I also get a lot of satisfaction with my facial pain patients when I can see that the tension has left their faces, or they are in the office and realize that they feel better. Professionally, what are you most proud of? Patient education. We work incredibly hard to connect the dots for our patients so that they can truly understand what is going on with their teeth and what they can do about it. Every week we hear, “No one has ever explained that,” or “Now, I get it!” It is a great feeling knowing that we have empowered people to make their lives better. Additionally, it’s incredibly satisfying to be a part of Smile for a Lifetime. We have treated some amazing kids who would otherwise not have access to care. What do you think is unique about your practice? In addition to spending a lot of time educating our patients, we also spend a lot of time getting to know them and their families. We celebrate milestones in their lives with them, and enjoy relationships throughout their treatment and beyond. I have been known to send a mom our family’s favorite black bean soup recipe or suggest a book that I know they would enjoy. Greensboro, North Carolina, the location of my practice, is a small town, and I love that my patients are always stopping Dr. Mark Reynolds 6 Orthodontic practice Volume 4 Number 3 PRACTICE PROFILE Empowering patients through smiles PRACTICE PROFILE Volume 4 Number 3 Orthodontic practice 7 me around town to say hi. I really enjoy knowing my patients beyond their teeth. What has been your biggest challenge? Finding the right people to catch the vision of our practice. Getting people who are personally committed, technically excellent, and technologically savvy, all with a friendly, approachable personality can be challenging. I have been very fortunate to have a great staff supporting me all the way. What would you have become if you had not become a dentist? There are lots of things that I would like to do, but I think that due to my addiction to HGTV, I would have to be an architect or designer. Helping people design and build their dream home would be a lot of fun. What is the future of orthodontics and dentistry? Three-dimensional orthodontic treatment planning and diagnosis will soon be the norm. With this technology, we can see so many more things clearly. Soon we won’t know how we ever lived without the information. I think that this will also lead to a better understanding of the interrelationship of facial and occlusal development and overall health. Big strides are already being made in sleep medicine/dentistry, and more are on the way. What are your top tips for maintaining a successful practice? Build a great team. Get the best people, and then include them in the decision- making processes. A great staff can be full of incredible ideas, and the sense of ownership helps get them implemented quickly. The opposite can also be true — one bad apple can spoil the whole office, and patients can tell the difference. What advice would you give to budding orthodontists? Never stop learning. Right out of residency, it is easy to feel on top of the orthodontic world, but it’s not long before the really hard cases come along, and you realize that not everything was covered in class. There is so much information available. Go out there, and keep learning. What are your hobbies, and what do you do in your spare time? My family is really important to me. One reason I chose orthodontics is because it allows me to spend time with my wife and children. We love to travel, to camp, to hike, and to eat popcorn during family fun nights. Recently, we have begun running 5k races together. We are involved in our church and in our community. I love sharing so many different experiences with my kids and seeing those experiences through their fresh eyes. TOP 10 FAVORITES 1. Going to movies 2. Cars 3. HGTV 4. Coffee, lots of coffee! 5. My wife and four kids 6. Crab cakes 7. My Bible 8. Just about any Apple ® computer product 9. Getting outdoors 10. My soft tissue laser OP T oday’s orthodontic specialist is challenged like never before. With many orthodontists facing flat-to-declining patient starts, competition from other dental providers, and a more discerning healthcare consumer, it’s increasingly important to navigate a dramatically shifting marketplace and employ new strategies to truly differentiate your practice. This dramatic shift has been a topic of conversation at Ormco Corp., a leading manufacturer and provider of orthodontic technology and services. That’s why we invite you to learn about the strides Ormco is taking to support your practice in an ever-changing and competitive orthodontic industry. After conducting extensive market research with doctors and healthcare consumers around the world, we’ve been able to better understand your needs as a clinician today. This renewed understanding has led us to a new mission statement designed to truly focus our efforts on meeting your practice and appliance needs. Unveiled by Ormco President Vicente Reynal at our 12th Annual Damon Forum in February, the following mission statement illustrates our commitment to better your practice. Ormco builds trusted relation- ships with the orthodontists we serve, providing a breadth of innovative products and solutions to enhance their professional lives. Ormco is committed to helping orthodontists achieve their clinical and practice management objectives. Put more succinctly, “Your practice is our priority.” This new commitment and tagline —“Your Practice. Our Priority.”— is an overarching theme driving our future initiatives, and rooting our programs in customer dedication and support. From product development and educational programs to personalized service and practice marketing support, we’re taking action to serve as your valued practice partner. Ormco’s restructured customer rewards program demonstrates our desire to address popular practice demands. The concept of the program is simple – orthodontists earn points on purchases that can be redeemed for more products. Relaunched in February as the “Ormco Lifetime Rewards” program, customers in North America can now earn points on Ormco and AOA Lab purchases that never expire. In addition to redeeming points for Ormco products and services, members may also benefit from special offers and savings from affiliate companies, including the Gendex GXDP-700 ™ , i-CAT ® FLX, CaviWipes ™ , and Orascoptic HiRes ® 2 loupes. Since inception of our rewards program, we’ve awarded $40 million in free product to participating customers. Innovating for your practice When you think about the year ahead or the next 3 years, do you envision your practice growing, innovating, and adopting new technologies and techniques? For more than 50 years, Ormco has partnered with the orthodontic community to manufacture innovative products and solutions that enhance the lives of clinicians and their patients. Founded in 1960, Ormco— which is an acronym for Orthodontic Research & Manufacturing Company—is one of the few orthodontic suppliers with a fully operational and active research and development department dedicated to design and manufacture new treatment solutions that enhance patient treatment and positively impact practice efficiency. Driven by innovation, we’re proud to have introduced a number of notable “firsts” in the industry, including preformed bands, direct bonding with Optimesh ® , computer-aided design (CAD) brackets with Orthos ® , Copper Ni-Ti ® and TMA ™ wires, and the first completely esthetic passive self-ligating bracket with Damon ® Clear ™ . With a focus on product quality, clinical efficiency and esthetics, we released more new products in 2012 than any other year in the company’s history. Last year, our team introduced a new active self-ligating bracket system, Prodigy SL ™ , which provides maximum rotational control and proven bond reliability. Additionally, the Damon Clear product line — appealing to a Ormco. Your Practice. Our Priority. 8 Orthodontic practice Volume 4 Number 3 CORPORATE PROFILE wide consumer base with virtually invisible brackets — expanded to include both upper and lower arch brackets, and is now available in a convenient single-patient kit. We also introduced AdvanSync ™ 2, a molar- to-molar Class II corrector for simultaneous skeletal and dental corrections, plus a new compact Quad storage system to help organize your inventory. Digital orthodontics to differentiate your practice Did you know there are approximately 23 million U.S. adults who are interested in improving their smiles? Furthermore, a Boston consulting group study found that patients would pay a premium for treatment that is faster, more esthetic, and more comfortable. As a progressive doctor interested in increasing patient starts, we encourage you to explore today’s advanced digital orthodontic solutions. At Ormco, we’ve dedicated three decades of intensive research and development to create Insignia ™ Advanced Smile Design ™ , an all-inclusive digital solution that combines 3D diagnostic technology and interactive treatment planning with customized appliances to accelerate treatment times and increase precision results. An advanced technology to differentiate your practice, Insignia is especially appealing to adult patients seeking faster results, fewer appointments, and improved comfort. Today we’re proud to share that Insignia offers the world’s most expansive menu of treatment options, including Insignia Clearguide ™ Express, Damon Clear, Damon ® Q ™ , Inspire ICE ™ , and completely customized self-ligating and traditional twin appliances, making it the natural evolution in appliance choice. With the Insignia Clearguide Express aligner Figure 1: Simulated canal injected with ink CORPORATE PROFILE Volume 4 Number 3 Orthodontic practice 9 system, we’re helping you to address patient image concerns with a sleek, clear aligner tray that goes virtually unnoticed. Building upon Insignia’s advanced digital platform, we’re excited to launch the Lythos ™ Digital Impression System this summer. This innovative technology harnesses the power of digital scanning to overcome the inherent challenges associated with traditional impressions. With a small portable device, lightweight wand, and fast scan time, Lythos delivers a comfortable digital impression experience for staff members and patients. Mark Hillebrandt, Vice President of Marketing and Product Management at Ormco, stated, “Ultimately, we envision the orthodontic workflow to be 100 percent digital, from scanning of the patient to the creation of 3D digital treatment plans to custom digitally manufactured, labial, lingual, and clear aligner appliances.” With an easy-to-use, intuitive interface, Lythos streamlines the practice workflow with scans that are complete in less than 12 minutes. Unlike “photo capture” scanners, where feedback is displayed a few seconds after pushing a foot pedal, Lythos scans in real time, which means feedback is displayed as it is captured. The Lythos video uses the occlusal surface to register the position of the data to show in real time. Unique to the industry, Lythos offers a “cash back” rebate system, where customers are credited for every Insignia and/or Insignia Clearguide Express case submitted with a Lythos digital impression. With regular use of Insignia and Clearguide, Lythos scans are virtually free! Practice development support for your practice How are patients finding you in today’s digital landscape? From teens to adults, the Internet is driving patient engagement, fueling patient referrals, and generating a wealth of new patient leads. Social media trends and web behaviors of digital-savvy consumers have been analyzed and leveraged by Ormco for years. Targeting this growing online community, our consumer websites DamonBraces.com and InsigniaSmile. com offer current and prospective patients an engaging educational resource. Additionally, these sites help consumers find local Damon ® and Insignia ™ specialists via their popular Doctor Locator search tools that are accessible from the Web, Facebook, and web-enabled mobile devices. Over the past 3 years, our marketing efforts to drive consumers to these websites have yielded a 190% increase in consumer site visits, and a remarkable 360% increase in Doctor Locator searches. This translates into $82 million in potential practice revenue each and every month for our Damon and Insignia doctors. To support our customers’ local practice marketing and patient education campaigns, Ormco provides an online practice marketing resource with a complete range of marketing assets and staff training tools to help increase patient starts. Available 24/7, marketing.ormco. com hosts a library of patient imagery, consultation tools, practice videos, webpage assets, and more for doctors offering the Damon System, Insignia, Inspire ICE, and Prodigy SL. As a company, we have long advocat- ed the importance of clinical education and facilitate educational opportunities for our clinicians worldwide. Our flagship event in North America, the Damon ® Forum, hosts more than 1,300 orthodontic professionals and is the largest privately-sponsored orthodontic event designed for the entire orthodontic team. The Damon Forum is one of many events offered by Ormco’s comprehensive CE program known as the Lifelong Learning Series. Designed to support our customers’ clinical and practice success, regional seminars, in- office courses, and free online webinars enable doctors and staff to explore clinical innovations and practice management strategies from the industry’s top clinicians and consultants. In June and September 2013, we invite doctors to attend one of three “Technology Symposiums” hosted in Washington, D.C., Chicago, and Atlanta. With a focus on innovative technologies to advance clinical excellence and efficiency, the day and a half seminars address the latest in passive self-ligation, digital solutions, and Class II correction. Doctors can learn more about Ormco’s supportive CE offerings and register for upcoming events by visiting www.ormco.com/ education. The entire team at Ormco will continue to uphold its commitment to make your practice our priority. We look forward to serving as your trusted partner in 2013 and beyond! For more information, visit Ormco online at www.ormco.com. This information was provided by Ormco. OP Practice marketing resources on marketing.ormco.com Online doctor locators for practice growth . technology: part 3 Dr. Rohit C.L. Sachdeva 49 Volume 4 Number 3 Orthodontic practice 1 May/June 2013 - Volume 4 Number 3 EDITORIAL ADVISORS Lisa Alvetro,. J Dent Educ. 2007;71 (4) :48 7 -49 1. 9. Dentists: Doctors of Oral Health. American Dental Association Web site. http://www.ada.org /45 04. aspx. Accessed July