The Anatomy of an Opportunity

By Allison M. DiMatteo, BA, MPS

Scientific advances in biomarker research have led dentistry and medicine to consider saliva a viable diagnostic medium. The intricate composition of this body fluid, combined with emerging science designed to exploit its inherent capabilities, could potentially change dental practice, patient care, and usher in an age of individualized treatment protocol.

Part folklore and part scientific documentation, the history of saliva’s use as a tell-tale indicator of what’s taking place within the human body dates back centuries. In ancient China, an inability to swallow a handful of rice whole was a sign of guilt, since if an individual was nervous (as a result of lying, for example) and their salivary secretions dried up, they would be prohibited from making a food bolus. In the early 20th century, cytochemical tests of saliva were used to study such conditions as gout and rheumatism.

Much of the early work conducted in the saliva diagnostics field related more to an assessment of better understanding the composition of saliva and its function at the patient level in terms of supporting the ability to speak, lubricate, masticate, and function, as well as its effects on quality of life, explains William Giannobile, DDS, DMed.Sc,the Najjar Professor of Dentistry and Director of the Michigan Center for Oral Health Research at the University of Michigan School of Dentistry. Within the field itself, what has really greatly benefited saliva diagnostics research has been the support and investment by the National Institutes of Health (NIH), specifically the National Institute of Dental and Craniofacial Research (NIDCR), that enabled a merging of many earlier technological advances in engineering and chemistry for the examination of the many properties of saliva, he says.

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A Conversation with Dr. John Kois

This month, the founder of the Kois Center shares some of his insights on where the profession is, where it’s going, and how private continuing education programs can contribute.

INSIDE DENTISTRY (ID): How did your experience in dental school have a lasting impact on your career as a practitioner—on your philosophy as a teacher?

JOHN KOIS (JK): I am a graduate of the University of Pennsylvania School of Dental Medicine, and I completed my Periodontal-Prosthodontic training at the University of Washington. Both schools offered fantastic opportunities for me and were very progressive with their curriculum. The educational experience was wonderful, and I remain very grateful for the way it has framed my career. Even though I do not use many of the procedures I was taught, I learned to be a more critical decision maker. The most important contributions came from being exposed to gifted, passionate teachers who were my mentors. Dr. Ralph Yuodelis, Dr. D. Walter Cohen, and Dr. Morton Amsterdam were among the most influential.

ID: Tell us when and why you founded the Kois Center.

JK: The Kois Center was founded in 1995, based on the need for a comprehensive approach for continuing education. The goal was to create a graduate program for practicing dentists that was cohesive rather than a combination of different courses. The core courses were designed to create improved critical decision making (treatment planning), understanding function, and dentofacial evaluation. The implementation courses focus on periodontics, biomechanics, and implants have seen the most change driven by science and technology.

Many other courses are able to provide great information but that is not the same as education or teaching. Education is designed to create a more significant impact by transforming the student through a platform of understanding and commitment.

The ultimate purpose of the Kois Center is to create world-class performers. The individual practitioner in turn derives more confidence, gains improved clinical performance, understands the financial accountability of dental procedures, and has more satisfaction from the practice of dentistry. This is not possible without receiving feedback on results, which is demanding and it is not always much fun. It isn’t work or play but something entirely different. It is what Geoff Colvin describes in his book as “Deliberate Practice.”

ID: What are the key components of a postgraduate institute that dentists should look for when researching various facilities and/or programs?

JK: I think it is critical to avoid significant conflict of interest concerns. It is important to have a “safe” environment where practitioners can discuss failures and their problems. Another critical piece is the opportunities available for continuous growth. We have an annual symposium which addresses the new science that has been published only in the last year. This is the evidence-based platform that modifies existing systems leading to best practice parameters. We also have mentors that work closely with students inside and outside the classroom. They have become a critical support network to answer questions, provide follow-up information, and help with implementation struggles in private practice. The mentors and clinical instructors are an integral part of the infrastructure that enable us to be more like what Seth Godin refers to as a “tribe.”

ID: How has your vision for the institute grown or changed over the years?

JK: The outcome is more than I ever dreamed of because it is now being driven by the students themselves. Their feedback has helped to develop reputable methodology (checklist), accountability coaching, an execution system, and community learning to share and reinforce best practices and accelerate learning. It is so exciting to see the dentists’ confidence and capability increase; that is the priceless component. In addition, my son Dean is a prosthodontist and my daughter-in-law, Tara, is a general dentist. The opportunities we have practicing together add even more depth and credibility to the Teaching Center. I can understand the struggles of younger practitioners in today’s challenging times and benchmark the improvements from our systems.

ID: What are the obvious (and perhaps the not so obvious) differences between a university dental school environment and a private institute environment such as yours?

JK: My current faculty position at the University of Washington does not involve any administrative responsibilities; therefore, my comments would be speculative at best. I view the role of a dental school as creating core competencies, but they are still entry-level skills. Therefore, our major differences are because we are inherently very different. I see my role as creating continuous improvement for dentists already in practice. This environment is changing so fast, it is harder for dental schools to keep up.

ID: With so many changes in technology coming to every aspect of dentistry, what in your opinion are the most impactful for practitioners as well as for patients in terms of providing better treatment options and more predictable outcomes?

JK: In many respects the changes in technology represent “disruptive innovation” that may not always be better. It depends, of course, on how we frame the concept of better. When technology can help create more predictable outcomes, more cost effectively, then dental healthcare becomes more affordable and we can help more patients. Everyone wins in this scenario.

The real problem is that the changes are happening so quickly and we have fewer expert clinicians to learn from. This is why we incorporated our own research center without any commercial support and depend more heavily on a precalibrated user group. The real challenge here is continuing to grow our understanding because information is traveling at the speed of thought and it is not all correct. Our own Research Center, under the direction of Dr. Yada Chaiyabutr, has added another unique component. Her background has enabled us to provide targeted research that directly impacts daily practice. In addition, the Research Center does not have commercial financial support, which makes it much easier to avoid any conflict of interest and publish in refereed journals.

ID: Which technologies have had the biggest impact on your institution in terms of how and what you teach?

JK: Technologies that provide better diagnostic metrics provide the biggest impact with what I teach. This will reduce the emotionally or empirically driven decisions. For example, scanning technology can provide a comparative evaluation of tooth wear from one appointment to another. Explaining to a patient they have lost 29% of their tooth structure will provide more meaningful communication than just telling them their teeth are “wearing down.” Telling them that their teeth changed 3% in 1 year will be more influential than saying their teeth look a little shorter. It is often our lack of clear, objective data that allows one dentist to determine treatment needs that another dentist would judge to be inappropriate. All of our clinical decisions must begin by determining each patient’s risk for future disease, even before they have expressed it. This paradigm shift is based on the need for a wellness evaluation, not a reparative model. The technologies that have the biggest impact are those that lead to “precision medicine” that will create a more predictable dental healthcare model.

ID: Tell us about the typical dentist-student at the Kois Center. What do you think they have in common? What do they leave there with that they didn’t have coming in? Who is an ideal candidate for the center?

JK: That is easy. They really care about their patients and want to be proud of the treatment. In a nutshell, it is about caring, commitment to excellence, pride, making a living, and making a difference for humanity.

Source: Inside Dentistry

Is TMJ Disorder Causing You Needles Amounts Of Pain?

Most people suffer from grinding teeth, neck pain, headaches and migraines, and automatically link it to a doctors problem, and more than frequently go to the doctor for some form of pain treatment, little do they know that it could actually be a more severe case and it could be TMD (Temporomandibular Disease) which is dental related.

There are many possible causes of TMJ these include; Grinding of teeth, poorly fitting teeth, clenching of the teeth when stressed, head or neck injuries often linked to motor vehicle accidents. The Temporomandibular Joint is a very important joint as it connects the jaw to the skull, to work correctly they need to be properly aligned and the muscles to be working properly and smoothly. They are responsible for many of the jaw movements including eating, swallowing, yawning and talking.

After your diagnosis of TMJ disorder there is 2 main goals of treatment, these are; relieving the muscle of pain and massaging it using Ultra Low Frequency Transcutaneous Electrical Neural Stimulation, this also helps to relieve pain by inducing the body to release endorphins the body natural anaesthetic.

Stabilizing your bite – This means that an orthotic device is worn over your teeth and night. This is used to help create a bite that causes less strain on your jaw and skull and makes for a better quality of life and considerably less pain than you would usually get.

If you feel you have any of the symptoms and have previously not linked them to the syndrome TMJ then you should visit your dentist and have a consultation to determine whether you could be suffering from TMJ disorder.

Dentures Are A Quick And Effective Treatment For Tooth Loss

Missing teeth can cause discomfort and stress even for the best of us, and we would like a quick and easy solution to this problem. Your teeth are one of the most important parts of your body and you should not have to deal with some of them missing and damaged.

Missing teeth can cause pain and discomfort especially in terms of eating and chewing. Continuing to bite with missing teeth, causes discomfort to your gums and mouth in general. One of the most effective and quickest treatments available for the loss of teeth is a denture.

If you have lost your natural teeth, dentures are an immediate treatment that is available. Dentures not only take into account just the space of your missing tooth or teeth, it also takes into account the general health and function of the rest of your mouth and teeth.

You do not want to have a denture placed, and not be able to go along with your daily duties because it is stressful on your mouth. At the end of the day you use your mouth for many things and ultimately some of the most important.

One of the most popular forms of dentures are over dentures. This is where an x-ray is taken of your mouth to determine exactly where the problem is more accurately. When this has been done and your dentist can determine where treatment needs to be done, you will have implants placed into your jaw, usually only 2 are necessary, and then your dentures are simply placed and fixed onto the implants for a secure fitting. You not need to worry about the dentures slipping or clicking because they will be securely placed on top of the implant.