Administrative Offices 2015–2016
NDA Executive Offices
Robert H. Talley DDS CAE, Exec. Director
8863 W Flamingo Rd, Ste 102
Las Vegas, NV 89147
702-255-4211 • 800-962-6710 FAX 702-255-3302
[email protected] • www.nvda.org
PRESIDENT
PRESIDENT ELECT
VICE PRESIDENT
SECRETARY
TREASURER
PAST PRESIDENT
Brad Wilbur DDS
Lynn Brosy DMD
George McAlpine DDS
Richard Dragon DMD
Dwyte Brooks DMD
Mark J. Handelin DDS
Nevada State Board of Dental Examiners
Debra Shaffer-Kugel, Exec. Director
Rick B. Thiriot DDS, DSO Coordinator
Candice Stratton, Licensing Specialist
6010 S Rainbow Blvd, Ste A1, Las Vegas, NV 89118
702-486-7044 • 800-DDS-EXAM FAX 702-486-7046
[email protected]
www.nvdentalboard.nv.gov
Northern Nevada Dental Society
Lori Benvin, Exec. Director
161 Country Estates Circle, Ste 1B
Reno, NV 89511
775-337-0296
FAX 775-337-0298
[email protected] • www.nndental.org
PRESIDENT
VICE PRESIDENT
SEC./TREASURER
PAST PRESIDENT
Brandi Dupont DMD
Maggie Heinen DMD
Spencer Fullmer DDS
Perry Francis DDS
Northeastern Nevada Dental Society
Robert H. Talley DDS CAE, Exec. Director
8863 W Flamingo Rd, Ste 102
Las Vegas, NV 89147
702-255-4211 • 800-962-6710
PRESIDENT
VICE PRESIDENT
SEC./TREASURER
PAST PRESIDENT
FAX 702-255-3302
Jamie Marvel DDS
Jeremy Keener DDS
Todd Thompson DMD
Todd Wilkin DDS
Southern Nevada Dental Society
Bob Anderson, Exec. Director
Linden Peterson, Office Manager
8863 W Flamingo Rd, Ste 101
Las Vegas, NV 89147
702-733-8700
FAX 702-733-6062
[email protected]
www.sndsonline.org
PRESIDENT
PRESIDENT ELECT
SEC./TREASURER
PAST PRESIDENT
J. B. White DDS
Tina Brandon-Abbatangelo, DDS
Richard Featherstone DDS
Lydia Wyatt DDS
American Dental Association
211 E Chicago Ave, Chicago, IL 60611-2678
312-440-2500 • 800-621-8099
www.ada.org
ADA DELEGATES Mark J. Handelin DDS
Steven A. Saxe DDS
David M. White DDS
NDA Committees
Council on Access, Prevention and
Interprofessional Services
Council on Government Affairs
Michael Sanders DMD, Chair
David White DDS, Chair | Arnie Pitts DDS
Daniel L. Orr II DDS MS (anesth) PhD JD MD
Council on Communications
New Dentist Committee
Council on Ethics, Bylaws and Judicial Affairs
NNDS Health and Wellness Committee
Peter Balle DDS, Co-Chair
Daniel L. Orr II DDS MS (anesth) PhD JD MD, Co-Chair
Dwyte Brooks DMD, Chair
2
NDA Journal
Erin Anderson DMD, NNDS Chair
Emily Ishkanian DMD
Eric Dean DDS, Chair | William Clements DDS
Michael Day DDS | Perry Francis DDS
Gerald Jackson, DMD | Teresa Jackson | Tom Lavin MS
Kathy Pinson | J. Justin Wilkerson DDS
SNDS Health and Wellness Committee
Richard S. Walker DDS, Chair | Robert P. Anderson
Pamela Caggiano DDS | Tyler Christiansen DDS
Michael Duboff DMD | Peter A. Mansky MD
Council on Membership
Brad Wilbur DDS, Chair | George Rosenbaum DDS
Adam Welmerink DDS, NNDS Chair
Council on Sessions and Programs
Joel T. Glover DDS, Chair
Winter 2015–2016
4
Editor’s Message Daniel L. Orr II, DDS, MS (anesth), PhD, JD, MD
Nevada Dental Association
8863 W Flamingo Rd, Ste 102
Las Vegas, NV 89147-8718
PH 702-255-4211 • 800-962-6710
FAX 702-255-3302
EMAIL [email protected]
WEB www.nvda.org
NDA JOURNAL
Editor
Daniel L. Orr II, DDS,
MS (anesth), PhD, JD, MD
[email protected]
Publisher
LLM Publications, Inc.
800-647-1511
www.AssociationPublications.com
NDA Journal is published four times each year by the
Nevada Dental Association and state component
socie­ties. All views expressed herein are published on
the authority of the writer under whose name they
appear and are not to be regarded as views of the
publishers. We reserve the right to reduce, revise, or
reject any manuscript submitted for publication.
Materials: All articles, letters to the editor, photos,
etc. should be sent to Daniel L. Orr II, DDS, via email
to [email protected]. All chapter and committee
reports and business communications should be sent
to Robert Talley, DDS, Exec. Dir., Nevada Dental Assn.,
8863 W Flamingo Rd, Ste 102, Las Vegas, NV 89147,
Ph 702-255-4211 or 800-962-6710, Fax 702-255-3302.
Materials may be reproduced with written permission.
Subscription: Members receive each publi­c ation
as a membership benefit paid by membership dues.
Non-members may subscribe to the Nevada Dental
Association Journal for $50 annually.
Advertising Policy: All advertising appearing in the
NDA Journal and other Nevada dental publications
must comply with the advertising standards of the
Nevada Dental Association and its com­ponent societies.
The publication of an advertisement is not to be
construed as an endorsement or approval by the
publishers of the product or service being offered in
the advertisement unless the advertisement specifically
includes an author­ized state­ment that such approval
or endorsement has been granted. The publishers
further reserve the right to cancel any and all contractual
advertising agree­ments should an adver­tiser be engaged
in litigation con­cerning their product or service, or
should the product or service be in conflict with the
standards of the NDA or its component societies.
Advertising rates and speci­fica­tions are available upon
request. Contact Dan Hartzog, LLM Publications,
at 800-647-1511 ext 2229 or email [email protected].
Mailing: Send address changes to:
NDA, 8863 W Flamingo Rd, Ste 102, Las Vegas, NV 89147
REPORTS
6
9
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25
26
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NDA Executive Director Robert H. Talley, DDS, CAE
NDA President Brad Wilbur, DDS
SNDS Interim Executive Director SNDS President JB White, DDS
NNDS Executive Director NNDS President Anthony Ferreri
Lori Benvin
Brandi Dupont, DMD
UNLV SDM Report
FEATURES
Mercurial Madness: Toxic Analysis
and Double Standards Willis Eschenbach; Jane M. Orient, MD
12
The Radiopacity of Composite-Based Dental
Restorative Materials Joseph G. Mirci, DDS, MAGD; Matthew Kaefer
Cowboys Under the Mongollon Rim Glenn R. “Slim” Ellison
COLUMNS
18
22
11
31
32
Letters to the Editor
Calendar of Events
ADA- and NDA-Affiliated Products
ON THE COVER
Mercury is a chemical element with symbol Hg and atomic number 80. It is commonly known
as quicksilver and was formerly named hydrargyrum. A heavy, silvery d-block element, mercury
is the only metallic element that is liquid at standard conditions for temperature and pressure.
Discovered: 2000 BC. Melting point: -38.83 °C. Boiling point: 356.73 °C.
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Editor’s Message
Maggie’s Ears
T
Daniel L. Orr II, DDS,
MS (anesth), PhD, JD, MD
[email protected]
Dr. Orr practices OMS in Las Vegas,
is a Clinical Professor of Surgery
and Anesthesiology for Dentistry
at UNSOM, Professor and Director
of OMS and Advanced Pain Control
at UNLV SDM, and a member of the
CA Bar and the Ninth Circuit Court
of Appeals. He can be reached
at [email protected] or
702-383-3711.
Figure 1. Cougie and my spouse, Ali.
4
NDA Journal
he NDAJ article on service animals in the last issue reminded me of the Orr pets,
and Maggie’s ears in particular. It’s doubtful our pets qualify as service animals…
after all, they train us more than vice versa.
Anyway, part of my anesthesia residency experience at the University of Utah involved
rotations at the Hogle Zoo. The anesthesia department at times provided treatment for all
kinds of animals needing veterinary surgery. The U also had its own research lab where
animals were anesthetized for approved research. Animal physiology is often very different
from that of humans; for instance, when avians receive ketamine, they die. However,
during microsurgery training, ketamine was the drug of choice for our rats and rabbits.
At the Los Angeles County/USC/Medical Center, OMS residents were given the
opportunity to operate occasionally on animals at the LA Zoo. Once we resected a tapir’s
facial tumor. Unbeknownst to the OMS residents, the OM pathologist subsequently
brought the tapir’s tumor slides to our Friday morning path conference. After a few
furtive resident differentials were dismissed out-of-hand, OMS Director Duke Yamashita
asked Dr. Al Abrams, the pathologist: “Is it human?” Duke had once again demonstrated
why he was the director and we were mere residents.
Historically, dentists in Nevada treated animals at the request of veterinarians. As far
as I know, all these dentists provided the services without charge. OMS Gerry Hansen
had several simian patient photos displayed in his office. I recall a LVMPD canine that
needed a crown (cast gold) which was provided by a DDS. Over the years, I had
opportunities to help veterinarians treat equines, canines, and some impressive felines
like Cougie, Victoria, and Sinbad. (Figures 1, 2, and 3.)
Later, the Nevada State Board of Veterinary Medicine promoted NRS 638.090 which
states it is unlawful for any person to practice veterinary medicine, surgery, obstetrics or
dentistry without a veterinary license. I did not know about the statute until my own vet,
who happened to be president of the Board when the law was passed, called me again to
help him with what appeared to be a fibro-osseous lesion on a Dalmatian. I agreed but
then was told that I couldn’t touch the dog because of the new law. I suggested that he call
a veterinary dentist, to which he advised there weren’t any in Nevada. My immediate
thought was “oops!” NSB Veterinary Medicine fail. I said “no” the first couple of requests,
but then acquiesced. My recommendation now is to never supervise dentistry when one
Figure 2. White tiger Victoria.
Figure 3. Well-known entertainer Sinbad.
Editor’s Message
is regulated against touching the patient. (Teledentistry of
course is different in that the absence of touching is a
spacial, not regulatory, limitation.1,2)
I am not sure how the new law affected others, such as
equine dental technicians…there are a lot of horse teeth in
Nevada—more than the veterinarians could ever handle.
Many times, owners opt to adjust their own horses’ teeth;
are they practicing veterinary medicine without a license?
My vet said owners could take care of their own animals. It
would not be surprising if this economically driven
veterinary regulatory restraint reminded one of the
Oklahoma’s Tooth Fairy Case in 20143, in which a school
nurse was ordered to not remove loose deciduous teeth.
All this brings us to Maggie’s ears. Maggie is one of our
Basset Hounds, and Basset Hounds have singularly
impressive ears. To quote the old Boy Scout song, they
hang so low: “…you can throw them over your shoulder
like a Continental soldier.” Basset Hounds often have ear
issues, like Maggie was diagnosed with after her recent
veterinary appointment. Our vet gave us some antibiotic
solution, a special rinse, a p.o. analgesic, and instructions
to clean out Maggie’s ears. Apparently there are no DVM
ENTs in Las Vegas either.
My lovely daughter Holly is responsible for our pets
(Maggie, her sister Lily, Henry our mutt, and Rocky the
Bearded Lizard) this quarter so she was assigned Maggie’s
ear duty.
Having had some experience with human ears from time
to time (Figures 4, 5), I volunteered to assist Holly with
Maggie, remembering my Mom’s valuable advice to never
put anything other than your elbow into your ear, after I
had put something other than my elbow in my ear with
unfavorable results.
After bringing home some H2O2, cotton balls, gloves, an
irrigation syringe, and my 12" forceps (Figure 6), we
Figure 7. Happy girls Lily, Maggie, and Holly.
prepared for Maggie’s procedure. Lily, Maggie’s loyal pal,
really got in the way trying to comfort her poor sister
during the procedures. Henry was pretty excited too, but
he weighs less than 10 pounds so wasn’t a problem, other
than the yapping. Maggie was pre-medicated with her
analgesic Rx and we talked her through the process with
supplemental “OK” anesthesia (“It’s OK Maggie, it’s
OK…”). Maggie was cooperative in spite any discomfort
she was feeling. We made steady progress over the course
of treatment and even received some positive reinforcement
from our vet for a job well-done. (Figure 7)
To my mind this procedure was at least as technically
demanding as some of my animal dentistry of years past,
and arguably at least as risky. I mentioned this to my vet
and am pretty sure I got the look that said he sure didn’t
want to mess with Maggie’s ears. But, it was gratifying to
work with Holly and to help Maggie under the direction of
our vet, and hopefully in compliance with yet another
compassionate health care law. ■
References
1. Tham TF, Teledentistry: Part 1,
an Overview, NDAJ 17:2, 16–18,
Summer 2015.
2. Tham TF, Teledentistry: Part
2, Legal Considerations, NDAJ
17:3, Fall 2015.
3. Orr D, Of Insurance Consultants,
of Tooth Fairies, and Luke, NDAJ
16:2, 4–5, Summer 2014.
Figure 4. Aural base.
w w w.nvda.org
Figure 5. Avulsion.
Figure 6. Ear armamentaria.
Winter 2015–2016
5
NDA Executive Director’s Message
T
Robert H. Talley, DDS, CAE
[email protected]
“Happy New
Year to all of
our members!
I hope your
holiday
season was
happy and
safe.”
he Annual NDA Mid-Winter Meeting will be held Saturday, Jan. 30, 9:30 am
in Las Vegas at the Springs Preserve, 333 Valley View Blvd at Highway 95.
Participants will have the opportunity to visit the Nevada State Museum and
explore the many features of the historical park.
Also, be sure to save the date for the NDA Summer meeting being held in Napa Valley,
CA at the Meritage Resort on June 16–18, 2016. A complete signup and itinerary will be
on the website soon and be included in the next NDA Journal.
The 156th annual convening of the ADA House of Delegates (HOD) completed its
deliberations on Nov. 10 at the 2015 ADA Annual Meeting in Washington, D.C.
Attending the HOD meeting were delegates David White, Steve Saxe, Brad Wilbur, and
Executive Director Robert Talley.
The ADA House of Delegates (HOD) conducted four sessions including the election of
Dr. Gary Roberts of Louisiana as President-elect and Dr. Irene Marron-Tarrazzi of
Florida as Second Vice-President. The HOD installed Dr. Carol Summerhays of
California as President. Over 90 primary and amended resolutions were considered
during the sessions and some are of special interest.
•The HOD approved a budget of $131.8 million with no ADA dues increase.
The Association’s reserves are at 54%.
•Resolution 12 passed which states that the ADA supports the concept
of “Medical Loss Ratio” for dental plans and will support states in their
efforts to require dental plans to report Medical Loss Ratio annually.
•Resolution 77 on anesthesia guidelines was referred back to the appropriate
counsel for further work.
•Resolution 98 was passed to eliminate the Tuesday meeting of the HOD
no later than 2017.
These are only a few of the resolutions and please call with any questions. Watch your
ADA News for more on the annual meeting.
Congratulations to Anthony Ferreri, NDA Director of Member Services, on being
named Interim Executive Director of the Southern Nevada Dental Society. ■
Save
t
date!he
NDA Mid-Winter Meeting
Saturday, Jan. 30, 2016
9:30 am
Springs Preserve, Las Vegas
333 Valley View Blvd
Visit www.nvda.org or call 702-255-4211 for details.
6
NDA Journal
w w w.nvda.org
Winter 2015–2016
7
NDA President’s Message
A
s the holiday season ends, and the New Year starts, it is an appropriate time to
reflect, and give thanks for things that make our lives better. Let’s start with one
of the exceptional ones.
The American Dental Association has partnered with DRB (Darien Rowayton Bank)
to sponsor a program that dentists can use to refinance their student debt. The benefit of
ADA membership is that the dentist gets an extra 1/4% off their rate. The extra 1/4% more
than pays for their whole ADA membership, so this is truly a win-win situation! Dentists
need to qualify for the loan, based on credit score and income, but another great part of
the loan is that it can be refinanced. That way, if the dentist increases their income and
raises their credit score, they can re-apply, and get better rates. With the burden of
student debt still increasing, the value of this program cannot be understated. The
American Dental Association receives no compensation for this program, but the fact
that this will be so great for membership indirectly affects us all.
People are another one of my reasons to give thanks. We are blessed to have the finest
group of local and state staff in my 34 years in Nevada. The local and state staff keep our
societies running; they are first contact for vendors, suppliers, and legislators. If they
don’t do their job, then we’ve already found ourselves in a hole out of which it’s tough
to dig. They are generally the first people that potential members contact, so having
top- notch staff in place will pay dividends leading to increased membership. Make sure
to thank our staff when you see them.
Local societies have also assembled dynamic leadership personnel. Innovative ideas are
now being initiated in the SNDS and that, along with changes in the New Dentist
subcommittee have allowed us to see increases in membership, and a new-found vibrancy.
Now if I can figure out how to get the Christmas tree back in its original box we will
have a “real” Holiday Season happy ending! I hope to see everyone at the Summer NDA
meeting at the Meritage Resort in Napa, CA, June 16–18, 2016. ■
the
Save e!
dat
Brad Wilbur, DDS
98th Annual Summer Meeting
June 16–18, 2016
Napa Valley, California
Rooms start at $269
($20 resort fee not included)
Reservations: 855-890-3705
http://meritageresort.com
Group Name:
Nevada Dental Association
Cut-off date: May 22
For more information and reservations, please visit www.nvda.org/summermeet.shtml
w w w.nvda.org
Winter 2015–2016
9
Letters to the Editor
Dear Dr. Orr,
Thank you for your recent editor’s message about
recent changes in the prescription monitoring
program. I agree that the PMP site is not going
to do much good in control over prescribing.
At best it will catch a few employees that write
themselves some scripts. It seems like all the
“rules” associated with the site, like changing your
passwords to something you can’t remember every
90 days, are designed to frustrate the average
dentist and drive them into non-compliance.
—Steve Sill, DDS
Dear Dr. Orr,
Thank you so much for the article on service animals in the Fall edition of the
NDA Journal. My service partner, Chloe, and I are at most of the dental events.
I spend a lot of time trying to answer awkward questions.
This is a highly sensitive subject and requires patience and under­standing by
all humans. Above all, however, there are the unsung heroes, canines and other
creatures, that improve our daily existence by providing any number of special
tasks and assistance.
Thank you again for your timely article.
—Barry Lasko, DDS, and Chloe
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Winter 2015–2016
11
Mercurial Madness:
Toxic Analysis and Double Standards
By Willis Eschenbach and Jane M. Orient, MD
Abstract
Mercury is a known neurotoxin. Current U.S. regula­
tory efforts through the Environmental Protection
Agency (EPA) are directed toward controlling tiny
amounts of additional mercury deposition. Treatment
of data regarding mercury reveals flawed methods of
analysis that can lead to absurd conclusions, yet the
conclusions are used to justify draconian, costly
regulations of U.S. energy-producing industries. Other
sources of mercury, in contrast, particularly in medical
applications, are not subjected to a similarly rigorous
standard, despite the potential for much greater harm.
Introduction
The phrase “as mad as a hatter” was inspired by symptoms
of mercury poisoning suffered by hat makers as a
consequence of the use of mercury in the process of curing
felt. Isaac Newton probably suffered mercury poisoning
from his experiments in alchemy, as described in the book
Newton’s Madness: Further Tales of Clinical Neurology by
Harold L. Klawans. Minamata disease, a neurologic
syndrome, was caused by severe mercury poisoning from
eating shellfish and fish from Minamata Bay into which
industrial wastewater had been dumped. Acrodynia or
“pink disease” was once a common and sometimes fatal
disease in infants before mercury was removed from
teething powders, diaper rinses, and laxatives.
Such occupational exposures, public exposures from
concentrated industrial dumping, or medical or dental
exposures, are not the subject of new regulations. Rather,
the U.S. Environmental Protection Agency (EPA) is
concerning itself with diffusing tiny amounts of mercury
emitted from coal-burning electrical generating stations.
Mercury and Air Toxic Standards for power plants have
been challenged in court by various industry groups and
states, and the case Michigan v. EPA has reached the U.S.
Supreme Court. The rule would require approximately
1,400 U.S. power plants to emit about 75 percent less
mercury starting in 2016.1 EPA calculates that these rules
would save the lives of about 11,000 people per year.
However, none of these lives are saved by the reduction of
12
NDA Journal
mercury. Instead, they are all due to the “co-benefits” of
other reductions resulting from the rule.
Sources of atmospheric mercury
About 7,500 tonnes of mercury are emitted into the
atmosphere each year from natural and anthropogenic
sources. By far, the largest emitter of atmospheric mercury
is the ocean. Other huge emitters are various lightly
vegetated land areas. In addition, forests, volcanoes, and
geothermal events are significant emitters (see Figure 1).
North America contributes a rather small fraction of
anthropogenic mercury admissions, as shown in Figure 2.
The bar labeled “stationary combustion” is mostly coalfired power plants. This is what EPA is targeting with its
restrictions. U.S. power plants were responsible for about
64.1 tonnes of mercury in 2008, or 1 percent of the total of
all mercury emissions.
Figure 1. S ources of Atmospheric Mercury. Named countries
show anthropogenic emissions for that country
Mercurial Madness
Anthropogenic Mercury Emissions
North America and Rest of World
Figure 3. Areas of High Mercury Concentrations in Fish. [Source: EPA’s Mercury Maps]
Rest of World
N. America
Figure 2. Sources of Anthropogenic Mercury Emissions (tonnes per year).
EPA restrictions will not cut all emissions of mercury
from coal-fired power plants, but let’s assume that they
can cut out 25 tonnes of mercury per year. It’s supposed
to save 11,000 lives every year. If 11,000 lives could be
saved by cutting only 25 tonnes, how many lives could
be saved by cutting 100 percent of these mercury emissions?
The 25 tonnes are only 1/300 of the total (25/7,500), and
300 times 11,000 gives 3.3 million lives saved every year.
No one can imagine that we are losing 3.3 million lives per
year from mercury poisoning. Therefore, EPA’s assertion
that its mercury rule will save 11,000 lives every year is
absurd. Quod erat demonstrandum.2 It is only by including
the hypothetical “co-benefits” (from reduction of small
particulates, PM2.5s) that EPA can make this claim, which
means the mercury is irrelevant. In fact there is not one
single preventable death attributable to mercury reduction
in their projected impacts.
or naturally occurring in soil may end up as organic mercury
in fish. Fish and shellfish consumption is the route by
which mercury emissions into the atmosphere affect the
general public. The mercury accumulates as it moves up
the food chain.
Areas of the United States where fish have high levels of
mercury are shown in Figure 3. The white areas of the map
represent those that have not been tested. The EPA threshold
of fish safe to eat is 0.3 parts per million (the two lightest
shades of red).
The total mercury concentration in the atmosphere above
the U.S. in 2010 is shown in Figure 4. The hot spot in the
center of the U.S. reflects natural mercury coming from
deserts and croplands.
Deposition of mercury in the environment
Mercury emitted by power plants, forest fires, automobiles,
and so forth is primarily of two kinds: divalent and
elemental. Elemental mercury (written as “Hg0”) means
atoms of mercury vapor. It doesn’t combine with much and
is insoluble, so it has a fairly long atmospheric half-life, on
the order of a year or so. Divalent mercury (written as HgII)
exists in the form of compounds such as mercuric chloride
(HgCl2). These compounds are both water soluble and
chemically reactive, so that they are quickly removed from
the atmosphere through deposition by precipitation.
Elemen­tal mercury is slowly changed into divalent mercury
in the atmosphere. Mercury deposited from the atmosphere
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Figure 4. Atmospheric Mercury Concentration above U.S.
Continues on page 14 
Winter 2015–2016
13
Mercurial Madness, CONTINUED FROM PAGE 13
The mercury deposited in soil is shown in Figure 5. One
might expect that areas downwind from coal-fired power
plants would have the highest amount of mercury deposited
by precipitation. However, this is not the case. The arrow
shows the direction of winds from coal-fired power plants
in Ohio to Pennsylvania, which surprisingly does not have
high levels of mercury deposition. Deposition is much
higher near San Francisco Bay. Basically, the figure is a
weather map. Note that the main flow of air in the U.S. is
from west to east. When moist air sweeps in from the
Pacific and hits the coastal mountains, it rains and deposits
the natural mercury from the ocean. Further inland on the
east side of California are the western slopes of the Sierra
Nevada Mountains. They get the moisture that doesn’t fall
on the coastal ranges. These high mountains remove most
of the moisture from the atmosphere, leaving Nevada with
little mercury deposition. The natural hot spot over the
Southwestern U.S. precipitates out in the central U.S., aided
by moist air flowing in from the Gulf of Mexico. This can
be seen all along the Gulf Coast; Florida also has a high
level of oceanic mercury deposition.3
Figure 5. Total Mercury Wet Deposition in U.S., 2010
What’s happening to mercury levels in fish?
When mercury in swordfish was the public scare of the day,
a study of swordfish and tuna, by the Smithsonian Institu­
tion and other natural-history museums, was published in
Science in 1972, comparing mercury levels in fish caught
between 1878 and 1909, before there were many coal-fired
power plants, to tuna caught in 1971. It turned out that the
concentrations were about the same.4 Apparently, the earth
is periodically showered with mercury from volcanoes and
other sources.5
To blame human activity and impose regulations, it is
necessary to show an increase in concentration. And the
“tuna time bomb” has been found. Over the past 17 years,
researchers conclude, writes Brian Palmer in the magazine
14
NDA Journal
of the Natural Resources Defense Council, “concentration
of mercury in yellowfin tuna has increased by approximately
3.8 percent annually. At the current rate of mercury emission,
they could become a very dangerous thing to eat in a decade
or two.”6
Because the authors of the cited study,7 to their credit,
posted the data along with the study, it is possible to assess
whether it supports their conclusion.
There were three samples of tuna studied, which were
caught in 1971, 1998, and 2008. Figure 6 shows a box plot
of the raw data. In the figure, the width of the box is
proportional to the number of data points. Boxes show
where half of the data is located. The heavy black line is the
median of the data. The notches are the error intervals on
the median. Units are parts per million (ppm).
The authors removed the big fish and the small fish, and
the two outliers that have mercury values of 1.32 and 0.15
ppm. Once those are removed, the results are as shown in
Figure 7. Note that because of the greatly reduced numbers
in the 2008 data, the uncertainty notch has become much
wider, and the width of the box is smaller.
The authors’ next step is to adjust the mercury content for
the weight of the fish. This is important because as the fish
gains weight, it bioaccumulates mercury. Figure 8 shows
what happens to the reduced data set once the mercury
content has been adjusted (either upwards or downwards)
depending on the weight of the individual fish. The
adjustment is not simple. At a critical body mass, the tuna
develops the capability to find prey in deeper, colder water.
Below a certain weight, there is not a linear relationship
between mercury concentration and size.
This made some obvious changes in the results. First, the
outliers have been greatly reduced, as has the range of the
data because the outliers were heavy fish with lots of
mercury, so that when they were adjusted, their mercury
levels came down. And curiously, while there is not a large
change in the median and spread of the 1971 and 1998 data,
the mercury concentration in the 2008 data has risen
noticeably. While the adjustment process reduced the error
of the median in 1971 and 1998 data, it actually increased
the error of the median in the 2008 data. The results are
still not statistically significant even at the weak P=0.05
level. Now these are the results that they claim to show that
the mercury in these tuna is “increasing at a rate of at least
3.8% per year.” If anything, the mercury level fell during
the period for which we have good data, from 1971 to 1998.
This would mean that the entirety of the purported
increase occurred over 10 years, after being stable for
nearly 30 years. This is simply not plausible.
Why did the results in 2008 move up so much owing to
the adjustment by weight? The problem is the weight distri­
bution of the fish in three groups. Figure 9 shows the same
Mercurial Madness
Figure 6. Box Plot of the Tuna Mercury Data by Year of Collection
Figure 7. Pacific Yellowfin Tuna Mercury Levels with Reduced Data
Figure 8. Pacific Yellowfin Tuna Mercury Levels, Reduced Data Set,
Adjusted for Fish Weight
Figure 9. Pacific Yellowfin Tuna Weight, Reduced Data
three groups, but this time each shows the weights of the fish
instead of the mercury levels. The distributions of the
weights of the fish caught in 1971 and 1998 are quite similar,
but the fish in the 2008 sample are predominantly small.
In summary, these authors have built their entire claim of
an increase in mercury on a mere 14 fish, 6 percent of the
data, which are lighter in weight than the other 94 percent of
the sample.8 This analysis shows the importance of looking
at the raw data before drawing conclusions about one data
set, and certainly before extrapolating the results to the
whole world.
It’s important not to assume that an increase in
mercury content of fish, even if genuine, is necessarily
due to an increase in anthropogenic emissions.
Methylmercury levels in fish do not depend simply on
the amount of elemental mercury available for
conversion. It’s also important that the accumulation of
the biologically active form of mercury depends on a
variety of factors such as the amount of sulfate, sunlight,
and organic matter; pH level; water temperature; and the
w w w.nvda.org
Continues on page 16 
Winter 2015–2016
15
Mercurial Madness, CONTINUED FROM PAGE 15
population of bacteria or zooplankton. A simple change in
bacterial activity alone could increase fish mercury
concentrations even as atmospheric deposition decreases.9
What is a safe level of mercury?
EPA calculates a reference dose (RfD) using a large number
of judgments and very conservative uncertainty factors.
From this it calculates that an intake of 0.1 mcg
methylmercury per kg per day could be consumed every
single day over a lifetime of 70 years without appreciable
risk of deleterious effects. This is the most restrictive RfD
level for mercury in the world.
When calculating the deleterious effects of exposure to
mercury in fish, and hence the hypothetical benefits of
regulation, EPA assumes that 6 percent of all pregnant
women in the U.S. fish for food and eat as much as 300
pounds of lake fish in a year. It calculates that the exposure
to their unborn children will lower the children’s IQs by an
average of 0.009 points. The average IQ test has a margin of
error of about five points. EPA assumes that each IQ point
lost would reduce each exposed child’s future earnings
potential by $892–$1,958 annually. From this it calculates a
maximum total benefit of the mercury reductions from its
most expensive rule ever of $6 million.1,7
Different agencies give different values for the safe
cumulative dose of mercury for infants less than 6 months of
age. Values for EPA, the Agency for Toxic Substances and
Disease Registry (ATSDR), and the U.S. Food and Drug
Administration (FDA) are given in Table 1.
Table 1. Exposure Limits for Mercury for Infants Less Than 6 Months Old
5th Percentile
Body Weight
50th Percentile
Body Weight
95th Percentile
Body Weight
EPA
65 mcg
89 mcg
106 mcg
ATSDR
194 mcg
266 mcg
319 mcg
FDA
259 mcg
354 mcg
425 mcg
Agency
Before the removal of thimerosal from vaccines was
precipitated by an amendment to the FDA Modernization
Act, signed into law Nov 21, 1997, an infant receiving all of
the recommended vaccines could have been exposed to a
cumulative dose of mercury as high as 187 mcg by
six months of age. The vaccines contained 25 mcg of
thimerosal, which is 50 percent ethylmercury, per dose.
It is simply assumed that ethylmercury is not as dangerous
as methylmercury because it is metabolized more quickly.10
There is a striking disparity between regulatory policy for
the industry that generates 40 percent of America’s electricity
and that for the pharmaceutical industry. Emissions from
coal-fired plants could be responsible for only a tiny
16
NDA Journal
fraction of person’s mercury exposure from fish, whereas
the dose in vaccines is injected in boluses, at a time when
the nervous system is developing rapidly. Moreover,
vaccines are mandated to be given to most infants.
Public health authorities have not calculated theoretical
fractional IQ point losses from increased doses of thimerosal
in vaccines, but have stated that its removal was a purely
“precautionary” measure and that “the evidence favors
rejection of a causal relationship between thimerosalcontaining vaccines and autism.”11 A full discussion of this
topic is beyond the scope of this article, but note that
controversy still exists. For example, there is evidence that
the mercury burden is higher in children with autistic
spectrum disorders;12 there is a dose-response relationship
between increasing mercury dose and prevalence of
neurodevelopment disorders;13 and while autism has
increased enormously, the possibility that mercury may
affect the immune system of certain genetically
predisposed children and trigger autism upon their
exposure to MMR has never been conclusively ruled out.14
In 2000, the late Hilton Terrell, MD, PhD, commented on
the double standard:
Other government agencies have long fulminated
against mercury in the environment, making the absurd
assumption that there is no threshold exposure beneath
which the element is safe.
Recently, an alert somebody noted that the preservative
in the vaccine for hepatitis B contains thimerosal, a
mercury compound. Calculating the mercury exposure
per unit of body weight of newborns, the absurdly low
acceptable amounts were transgressed. The vaccine might
cause mercury toxicity! We are now told to wait until the
infant is two months old before beginning the three shot
series. They are working on a mercury-free vaccine.
Now, this collision between two elements of central
control is only a fender-bender. We are assured, “...no
known harm has occurred...,” and that is due to
theoretical concerns. It is interesting to stand by and
listen to the investigators at the scene of the collision.
The U.S. Surgeon-General says, “The risk of devastating
childhood diseases from failure to vaccinate far
outweighs the minimal, if any, risk of exposure to
cumulative levels of mercury in vaccines.”
One is tempted to step out into the broken glass in the
street and ask these investigating officers, “Why cannot
the same reasoning be applied to other minimal risks? …
Why can’t the industry down the road legally discharge
3 milligrams of mercury into the sewage system each
day? Why can’t I legally drop an aluminum pull tab
from a soft drink can into the Atlantic Ocean nine miles
offshore?”15
Mercurial Madness
A fiscal note
The Regulatory Impact Analysis of the proposed Mercury
Toxic Rules says:
This proposed rule will reduce emissions of Hazardous
Air Pollutants (HAP) including mercury from the electric
power industry. As a co-benefit, the emissions of certain
PM2.5 precursors such as SO2 will also decline. EPA
estimates that this proposed rule will yield annual
monetized benefits (in 2007$) of between $59 to $140
billion using a 3% discount rate and $53 and $130 billion
using a 7% discount rate.
However, according to Table 1.3 in EPA’s own analysis,16
mercury only has benefits of $.004–$.006 using a 3 percent
discount rate, and $0.000005–$0.000009 billion using a
7 percent discount rate.
Now, we have to admire their honesty. They’ve given all
of the monetary values in billions of dollars, with their
estimates of total benefit ranging from $50 billion to $140
billion. And they’ve given their estimate of the benefits
from the mercury reduction using a 7 percent discount rate
in billions of dollars as well: $0.000005–$0.000009 billion.
In human-sized figures, that’s a total nationwide benefit
spread out across the population of $5,000–$9,000 from
the proposed reduction in mercury.
With that kind of trivial benefit, the cost-benefit of
including mercury in this regulation must be strongly
negative. It should be removed from the bill under the
EPA’s own requirement that the cost-benefit analysis of a
regulation must show a net benefit (positive).
In contrast, the amount spent on autism research is
trivial, although the burden of autism will likely mount
into trillions of dollars.14
References
1. Potts B. Mercurial regulators making fishy calculations. Wall Street Journal, Mar 23, 2015.
Available at: http://www.wsj.com/articles/brian-potts-mercurial-regulators-making-fishycalculations-1427153569. Accessed Apr 18, 2015.
2. Eschenbach W. The EPA’s mercurial madness. Watt’s Up With That? Mar 31, 2015. Available
at: http://wattsupwiththat.com/2012/03/31/the-epas-mercurial-madness/. Accessed Apr
18, 2015.
3. Eschenbach W. Mercury, the trickster god. Watt’s Up With That? Apr 1, 2012. Available at:
http://wattsupwiththat.com/2012/04/01/mercury-the-trickster-god/. Accessed Apr 18, 2015.
4. Miller GE, Grant PM, Kishore R, et al. Mercury concentrations in museum specimens of tuna
and swordfish. Science 1972;175:1121-1122.
5. Techentin JD. Letters. New EPA mercury rules are inconsistent and illogical. Wall Street
Journal, Apr 3, 2015. Available at: http://www.wsj.com/articles/new-epa-mercury-rules-areinconsistent-and-illogical-letters-to-the-editor-1428089614. Accessed Apr 18, 2015.
6. Palmer B. Tuna time bomb on Earth. Available at: http://www.onearth.org/earthwire/tunamercury-levels-rising. Accessed Apr 18, 2015.
7. Drevnick PE, Lamborg CH, Horgan MJ. Increase in mercury and Pacific yellowfin tuna. Environ
Toxicol Chem 2015; 34: 931-934.
8. Eschenbach W. Something fishy about mercury. Watt’s Up With That? Feb 5, 2015. Available
at: http://wattsupwiththat.com/2015/02/05/something-fishy-about-mercury/. Accessed Apr
18, 2015.
9. Soon W. A Scientific Reply to Specific Claims and Statements in EPA’s Proposed NESHAP
Rule, Focusing on Mercury Emission Issues. Science and Public Policy Institute; July 21, 2011.
Available at: https://www.cfact.org/pdf/Scientific_Critique_of_EPA_MercuryRule062011.
pdf. Accessed Apr 19, 2015.
10.Vaccine Education Center, Children’s Hospital of Philadelphia. Vaccines and Thimerosal.
Available at: http://vec.chop.edu/service/vaccine-education-center/vaccine-safety/vaccineingredients/thimerosal.html. Accessed Apr 19, 2015.
11. Olson DA. Mercury toxicity. Medscape Reference; Oct 20, 2014. Available at: http://emedicine.
medscape.com/article/1175560-overview. Accessed May 3, 2015.
12.Bradstreet K, Geier DA, Kartzinel JJ, Adams JB, Geier MR. A case-control study of mercury
burden in children with autistic spectrum disorders. J Am Phys Surg 2003;8:76-79.
13.Geier MR, Geier DA. Thimerosal in childhood vaccines, neurodevelopment disorders, and
heart disease in the United States. J Am Phys Surg 2003;8:6-11.
14.Yazbak FE. Autism in the United States: a perspective. J Am Phys Surg 2003;8:103-107.
15.Terrell HP. Mercurial logic. Med Sentinel 2000;5:66.
16.U.S. EPA. Regulatory Impact Analysis of Proposed Toxic Rule Final Report; March 2011.
Available at: www.epa.gov/ttn/ecas/regdata/RIAs/ToxicsRuleRIA.pdf. Accessed Apr 30, 2015.
Online CDE
Conclusions
U.S. EPA regulatory policies with respect to coal-fired power
plants and other industries, which impose enormous costs,
are based on questionable methods extrapolated to absurd
conclusions. Until fairly recently, mercury in mandated
pharmaceutical products was not subjected to scrutiny, and
is viewed under a remarkable double standard. ■
Willis Eschenbach is an independent scientist. He can be reached at
willis@surfacetemps. org. Jane M. Orient, MD, practices general internal
medicine and serves as AAPS executive director.
ADA CE Online www.adaceonline.org
Kerr Learning Source www.kerrlearningsource.com
Procter & Gamble Dental Care www.dentalcare.com
Wiley Health Learning www.wileyhealthlearning.com
SNDS CE Programs
To meet your needs, the SNDS has a full
menu of CE opportunities. You can mix
and match a CE program that suits your
interests, your schedule, and your budget.
Check out our schedule at www.sndsonline.org.
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Premier CE Series
brings world-class
speakers to Las Vegas
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Winter 2015–2016
17
The Radiopacity of Composite-Based
Dental Restorative Materials
Joseph G. Mirci, DDS, MAGD* and Matthew Kaefer—University of Utah
Abstract
The challenge with composite materials is to see
recurrent decay at the gingival margin on an X-ray. I
wanted to do a comparison of different composites on
actual teeth to see and compare radiopaque properties.
The goal of this study was to visually compare the
radiopacities of commercially available composite
restorative materials. Thirty-two different samples,
including six flowable composites, were placed as
restorations in the mesial and distal surfaces of
previously extracted molars. Each composite and an
11-step aluminum step-wedge1 were radiographed
using Schick CDR sensors and Patterson Dental digital
imaging, which can be purchased through Patterson
Dental. The Schick sensors have an image resolution of
.575 megapixels. The X-rays were taken with a Gendex
765 DC, with the setting of 65 kv 7 ma for 0.080 seconds.
See figure 1.
FIGURE 1
Materials and equipment
•
•
•
•
Gendex GX-770 x-ray machine
11-step aluminum wedge (07-456)
32 different composite samples
20 previously extracted human teeth
Visual analysis using GIMP 2.6.3 graphical software
was used to match each composite with the equivalent
thickness of aluminum as provided by the step-wedge.
The composites were compared to dentin and enamel
as well as amongst other brands. All the tested compo­
sites presented an aluminum equivalent thickness
greater than that of enamel and dentin and are in
accordance to the International Standards Organization.
Introduction
Amalgam fillings, are being utilized less as society
demands a more natural-looking alternative for dental
restorations. Composite-based restorative materials are
now common practice. Some benefits are esthetics, and
increased control of working time3. Composites may be
preferred by patients because they match the color and
appearance of the natural tooth structure. When properly
18
NDA Journal
placed as a restoration they are hardly noticeable in the
mouth, as opposed to amalgam.
The wear of composites has become less, and in some
cases is close to amalgam wear4. They are also more
expensive and have varying radiopacities (aluminum
equivalent value) depending on the brand5. Composites
consist of glass and ceramic particles in combination with
aluminum, barium, strontium, and zirconium6. These
heavy metals, varying in concentration, give the composite
its unique radiopaque character. See figures 2 and 3.
Typically, composites used for anterior teeth have smaller
particle sizes at lower concentrations than those intended
to be used for posterior teeth6.
Radiopacity is an important attribute of dental composites
because it affects the degree of material reflection. This
characteristic allows distinction from the natural tooth
structure on a radiograph. The radiopacity of a composite
must be greater than that of dentin and enamel in order to
clinically detect re-occurring or secondary6,7. It is also
essential in the evaluation of interproximal contour, material
voids or gaps, and marginal overhang8.
FIGURE 2
Composite based resins
• Composite materials consist of glass and ceramic particles
in combination with aluminum, barium, strontium, and
zirconium.3
• These heavy metals vary in concentration thus giving
the composite its unique radiopaque character.
• This study measured 32 different composites. (Table 1)
FIGURE 3
Flowable composites
• Flowable materials either have less filler or a higher
concentration of diluents in the composite depending
on the manufacturer. This usually leads to lower levels
of radiopacity.
• They provide higher flow and increased adhesion to the
wall of the cavity.
• As a result of their increased flow, they are easy to place
into the prepared cavity.
• Flowable composites used in this study: Grandio Flow,
Tetric EvoFlow, Virtuoso, UniFil Flow, Wave, and Permaflo.
(Table 1)
Radiopacity
The goal of our study was to visually compare the
radio­pacities of several composite restorative materials and
also to dentin and enamel. Research was performed for one
semester in a working dental office in Salt Lake City, Utah.
Table 1. Restorative materials and manufacturers used in this study.
Manufacturer
Product
3M Dental Products
Filtek Supreme A2B
3M Dental Products
Z250 A1
Coltene Whaledent
Synergy Duo Shade A2/B2
Den-Mat
Virtuoso A2 (Flowable)
Denstply Caulk
Dyract eXtra A2
Dentsply Caulk
Esthet-X A2
Dentsply Caulk
Mono Ceram-X M2
Dentsply Caulk
Quixx U
Dentsply Caulk
Surefil High Density A
Dentsply Caulk
Surefil SDR U
Dentsply Caulk
TPH3 A2
GC America
Gradia Direct P-A2
Mounting
GC America
UniFil Flow A2 (Flowable)
Preparation
Heraeus Kulzer
Charisma C3-23
Restoration
Heraeus Kulzer
Venus A2
X-ray
Ivoclar Vivadent
4 Seasons A2
Analysis
Ivoclar Vivadent
Helio Molar B3
Ivoclar Vivadent
Tetric EvoCeram A2
Ivoclar Vivadent
Tetric EvoFlow A2 (Flowable)
Kerr
Herculite B4
Kerr
Point 4 A4
Kuraray Dental
Clearfil AP-X PLT A2
Pentron
Simile B2
SDI
Ice A2
SDI
Wave A3 (Flowable)
Shofu
Beautfil A2
Tokuyama
Estelite E-Quick A2
Ultradental Products, Inc.
Amelogen Plus A2
Ultradental Products, Inc.
Permaflo A2 (Flowable)
Ultradental Products, Inc.
Vit-l-escence A1
Voco
Grandio A2
Voco
Grandio Flow A2 (Flowable)
Materials and Methods
The thirty-two composite materials evaluated in this study
are listed in table 1.
Twenty previously extracted human molars, all of similar
size, were set in dental stone with the crown exposed and
then prepared for the placement of composite restorations.
See figure 4. During preparation, 4mm wide by 3mm
(±0.5mm) deep wells were drilled in the mesial and distal
surfaces of the teeth. These measurements were established
by a caliper and were used because they closely resemble
the dimensions of actual clinical restorations. A bonding
agent, Clearfil, was applied to each surface and cured using
a Sapphire Plasma Arc Light. Finally, the composites were
placed and cured to manufacturer’s specification using the
same curing light.
FIGURE 4
All composite samples, including an amalgam restoration
and a virgin control tooth, were radiographed alongside an
11-step type-24 aluminum wedge (model 07-456) for
comparison. All specimens were radiographed using a
Gendex GX-770 digital X-ray machine. The images were
generated with Patterson Dental Imaging software. Visual
analysis of the radiographs was performed using GIMP
2.6.3 graphical software. The radiopacities of each composite
were visually matched with the equivalent thickness of
aluminum as provided by the step-wedge. The composites
were then compared to dentin and enamel as well as other
composite brands.
Results
Analysis of the radiographs showed a wide variety of
radiopaque character. All composites, enamel, dentin and
amalgam were measured as equivalent aluminum thickness
corresponding to the radiopacity of the steps on the wedge.
The wedge consists of 11 steps measuring from 5mm to
35mm of aluminum thickness, with 3mm increments
between each level. See figure 5.
A table was formed and sorted from the most radiopaque
to the least. Composites with the same radiopacity, as
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Continues on page 20 
Winter 2015–2016
19
Radiopacity, CONTINUED FROM PAGE 19
visually evaluated, were then sorted in alphabetical order.
The data for amalgam, enamel, and dentin is displayed at
the bottom of the table for comparison. The corresponding
step and equivalent aluminum thickness of the materials
are presented in Table 2.
FIGURE 5
Results
Upon analyzing the radiographs, only Unifil Flow seemed
to provide a notably low level of radiopacity in comparison
to the other test specimens.
However, when the radiopacities were expressed as aluminum equivalent thickness, the majority of the composites
showed levels in the range of 11mm or aluminum. This
was also observed for dentin and enamel which presented
11mm and 8mm of aluminum, respectively.
The most radiopaque composites were: Charisma,
Esthet-X, Helio Molar, and Mono Ceram-X. The full list of
composites can be seen in table 2.
Discussion
According to the International Standards Organization
(ISO 4049), the radiopacity of composites must be greater
than that of an equal thickness of aluminum9. However, a
moderate level of radiopacity is clinically preferred over a
high level10. Amalgam, with a very radiopaque nature
(23mm A1) does not provide an optimal condition for
detecting areas of low radiopacity, such as recurrent caries
near previous restorations.
Upon analyzing the radiographs, only Unifil Flow
seemed to provide a notably low level of radiopacity in
comparison to the other test specimens. However, when
the radiopacities were expressed as aluminum equivalent
thickness, the majority of the composites showed levels in
the range of 11mm of aluminum. This was also observed
for dentin and enamel which presented 11mm and 8mm of
aluminum, respectively. Therefore, all the materials tested
in this study presented a radiopacity in accordance to the
International Standards Organization9.
Another notable trend was the low mean radiopacity
value for flowable composites. The mean value for these six
flowable composites was 8.5mm A1. This is much lower
than the mean value obtained for the other twenty six
composites of 12.3mm A1. These flowable materials either
have less filler or a higher concentration of diluents in the
composite depending on the manufacturer11. This attribute
can be held responsible for their low radiopacity values.
They do however provide higher flow and increased adhesion
to the wall of the cavity. As a result of their increased flow,
they are easy to place into the prepared cavity.
The procedure of this experiment is similar to that used
in most other studies evaluating the radiopacity of dental
20
NDA Journal
Table 2. Materials and equivalent aluminum thickness.
Material
Corresponding
Aluminum
Equivalent Value
Step
Charisma C3-23
5
17mm A1
Esthet-X A2
5
17mm A1
Helio Molar B3
5
17mm A1
Mono Ceram-X M2
5
17mm A1
Clearfil AP-X PLT A2
4
14mm A1
Herculite B4
4
14mm A1
Quixx U
4
14mm A1
Surefil High Density A
4
14mm A1
Synergy Duo Shad A2/B2
4
14mm A1
Tetric EvoCeram A2
4
14mm A1
TPH3 A2
4
14mm A1
4 Seasons A2
3
11mm A1
Amelogen Plus A2
3
11mm A1
Dyract eXtra A2
3
11mm A1
Estelite E-Quick A2
3
11mm A1
Gradio A2
3
11mm A1
Permaflo A2 (Flowable)
3
11mm A1
Point 4 A5
3
11mm A1
Shofu Beautiful A2
3
11mm A1
Simile B2
3
11mm A1
Surefil SDR U
3
11mm A1
3
11mm A1
Venus A2
3
11mm A1
Z250 A1
3
11mm A1
Filtek Supreme A 2B
2
8mm A1
Gradia Direct P-A2
2
8mm A1
Grandio Flow A2 (Flowable)
2
8mm A1
SDI Ice A2
2
8mm A1
SDI Wave A3 (Flowable)
2
8mm A1
Virtuoso A2 (Flowable)
2
8mm A1
Vit-l-escence A1
2
8mm A1
Unifill Flow A2 (Flowable)
1
5mm A1
Amalgam
7
23mm A
Dentin
3
11mm A1
Enamel
2
8mm A1
Tetric EvoFlow A2
(Flowable)
Radiopacity
materials. In order to generate
radiographs that are representative of
clinical practice we chose to place the
composites in human teeth as actual
restorations. The amount of composite
used in the restorations is directly
correlated to the equivalent aluminum
thickness. Other studies may not obtain
the same values for radiopacity; however,
the general trends are similar.
In conclusion, only Unifil Flow
showed a notably different radiopacity
in relation to the other tested samples.
None of the composites presented a
value equal to that of amalgam. How­
ever, all the tested composites presented
an aluminum equivalent thickness
greater than that of enamel and dentin
and are in accordance to the Interna­
tional Standards Organization6. ■
References
1.www.margrafcorp.com/aluminum-step-wedges.html.
2. Rodrigues Cruvinel, Diogo, Lucas da Fonseca Roberti
Garcia, Luciana Assirati Casemiro, Luiz Carlos Pardini, and
Fernanda de Carvalho Panzeri Pires-de-Souza. “Evaluation
of radiopacity and microhardness of composites submitted
to artificial aging.” Materials Research. 10.03 (2007).
3. Hara, Anderson Takeo, Mônica Campos Serra, and Antonio
Luiz Rodrigues Jr. “Radiopacity of Glass-Ionomer/Composite
Resin Hybrid Materials.” Braz Dent J. 12.02 (2001)
4. Clinicians Report, July 2009, Vol. 2, Issue 7. “Has Amalgam
Been Replaced? Wear on Occlusal Surfaces.”
5. Journal of Endodontics, September 2008, Vol. 34(9):
1101–1104, doi:10.1016/j.joen 2008.06.004. “Differences
in Aluminum Equivalent Values of endodontic Sealers:
Conventional vs. Digital Radiography.”
6. Tirapelli, Camila, Fernanda Carvalhi Panzeri, Heitor Panzeri,
Carlos Pardini, and Osvaldo Zaniquelli. “Radiopacity and
microhardness changes and effect of X-ray operating
voltage in resin-based materials before and after the
expiration date.” Materials Research. 07.03 (2004)
7. Lopes Devito, Karina, Ana Isabel Ortega, and Francisco
Haiter-Neto. “Radiopacity of calcium hydroxide cement
compared with human tooth structure.” Journal of Applied
Oral Science. 12.04 (2004)
8. Tsuge, Takuma. “Radiopacity of conventional, resinmodified glass ionomer, and resin-based luting materials.”
Journal of Oral Science. 51.02 (2009).
9. International Standard Organization. ISO 4049: Dentistry
—“Polymer-based filling, restorative and luting materials.”
Switzerland: ISO; 2000.
10.Can DCN, Titus HW, Chung KH, Dixon H, Wellinghoff ST,
Rawls HR. Radiopacity of tantalum oxide nanoparticle
filled resins. Dent Mater 1999; 15:219-22.
11.Lutz, F., and I. Krejci. “Amalgam substitutes: a critical
analysis.” K Esthet Dent. 12.03 (2000)
Dr. Mirci practices
dentistry in Salt Lake
City, Utah, is a Clinical
Associate Professor
at the University of
Utah and has directed
Biology 3080, a
for-credit pre-dental
course, since 1995.
w w w.nvda.org
Winter 2015–2016
21
Cowboys Under
the Mongollon Rim
A
bout that time, I was havin a lot of aches in my
He put a lock on my head with his arm and fastened
jaw teeth. Big cavities. But with no dentists, you
onto the tooth, r’ared back, and pulled. The forceps
jist suffered, stuffed oil of cloves on cotton into
slipped off. My head was jumpin, but he hung on like a
‘em till the nerve deadened. I couldn’t drink cold water or
bulldog.
eat sweets without the old head tryin to blow up. My jaw
“Hold ever thing, when I lay holt of ‘er this time she’s
swelled up. In sitchiations like this you had to make yore
comin out.”
own medicine. Thar’s a little knot on each side of a horse’s
He squeezed my head a little tighter, layed holt, r’ared
front legs, jist above the knees, hard outside, soft inside.
back, pulled, and twisted. Ever bone in my head squeaked.
I’ve gotten down, when ridin, and shaved off the top of
“Damn! What yah got? A horse tooth?” He twisted again
one with my knife to git the soft part and roll it up into a
and out she come with roots sprangled out like a tree.
pill and stuff it into a tooth cavity to keep the air out. It
“Boy, that was the hardest one I ever tugged at,” he says.
helped a lot, and didn’t hurt the horse.
“I was afraid to turn yore head loose after that slip, you
One day Dad said, “Take two jacks and go to J.C.’s store
mite of run off.”
and git a load of grub.” That was two mile east of Pleasant
“No, I wanted it out, no matter what.”
Valley post office, making it about 35 mile, round trip.
I sort of quit bleedin and felt better, so took off. When I
When I got thar the old fang was still jumpin, and I was
got
to the store, J.C. helped me pack up.
in misery.
I didn’t feel like eatin. I hadn’t slept the night before and
J.C. said, “Old Man Leisure live down the creek about six
had already rode 28 mile and had 17 more to go with two
miles. He pulls a tooth once in awhile. It’s the first and last
pack jacks loaded.
house, you can’t miss it.”
I got home about 10 that nite, very tired. I’d taken a
I got on my pony and lit a shuck in that direction. It was
drink of water in the Valley and rinsed the clot of blood
a one-room shack made from posts stuck upright and
out of the socket. My whole head and jaws hurt. I hurt
chinked with mud; one door, a fireplace, and no windows.
ever where.
A big cottonwood tree stood in the yard and thar was a
After about two weeks my jaw hurt again and the gum
small orchard.
swelled up and I pulled a splinter of bone out where the
I told ‘im I heard he pulled teeth. He said, “Yes I pulled
tooth roots had splintered it. Healed up good after that. ■
my own and a few others. If I can find my forceps, we’ll
yank that thang.”
He stirred around on a shelf, then in a box, all dusty,
“Ah,” he says, “I found ‘em.”
They was rusted in spots. He wiped ‘em on his leg and
Editor’s note: From Cowboys
said, “Now, boy, we’ll stop that pain.”
Under The Mogollon Rim,
by Glenn R. “Slim” Ellison,
I told ‘im, “I ain’t got any money, but I got some quartz
University of Arizona Press,
here that’s more gold than rock, maybe a third gold.”
1968.
“Never ask yah for no money, don’t want it, but I’ll take
The book was provided to the
the rock for a specimen.”
Editor by Orrin Olsen of LDS
Philanthropies BYU, 801-422He pointed to a chair without a back on it and says,
8651, [email protected]. Orrin
“Set down thar and show me which one hurts.”
Olsen was an All-American
I did. “Now get a holt of them chair rungs and don’t turn
football player for BYU and
also played in the NFL.
loose till it’s out.”
22
NDA Journal
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Winter 2015–2016
23
SNDS Interim Executive Director’s Message
M
Anthony Ferreri
[email protected]
24
NDA Journal
any of you may know me as the Director of Member Services for the
NDA, and I’m pleased to announce that I’ve stepped in as Interim
Executive Director of SNDS.
I started at the NDA in late 2008 and have been working hard on improving
the membership application process and increasing the statewide member­ship.
With this new opportunity, I’m looking forward to using my skills and
connections that I’ve cultivated to help SNDS grow and become a united
organization. With our leadership, I am confident that this will happen.
If there’s anything that I can do for you, please don’t hesitate to contact me at
702-733-8700 or at [email protected]. Please make sure to join us
for our next monthly dinner meeting on January 21, 2016—you won’t want to
miss it! ■
SNDS President’s Message
Finding Flow in Your Practice and Life
T
here are countless ways to go
through life, but what if one way
leads to a more fulfilling exist­
ence than another? Many studies have
been done on what it means to truly
live. And when I say live, it’s not just
the automatic biological process, but
to live in the sense of a poet. To live in
fullness, without the waste of time
and potential, expressing one’s
uniqueness, and interacting intimately
with all the complexities of our
surroundings. When all our days are
inevitably over and we look back on
our life, will we say we were happy?
A psychologist from the University
of Chicago, Mihaly Csikszentmihalyi,
has spent his career studying happiness
and creativity, and is best known for
his notion of flow. Flow is the mental
state of operation in which a person
performing an activity is fully
immersed in a feeling of energized
focus, full involvement, and enjoyment
in the process of the activity.
Csikszent­mihalyi has found that it is
consistent flow moments or experiences
that ultimately leads to
excellence in life. It is the
number and frequency
for which one is lost in
the joy of the experience
that far outweighs wealth,
health, or fame that leads
to happiness.
Flow tends to occur
when a person’s skills are
fully involved in
overcoming a challenge
that is just about
manage­able. When you
are in flow, you are
completely focused.
There is no space in
conscious­ness for
distracting thoughts or
irrelevant feelings.
Self-consciousness
disappears and you feel
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stronger than usual. The sense of time
is distorted and hours seem to pass by
in minutes. Whatever you’re doing
becomes worth doing for its own sake.
Take a challenging clinical scenario
where a patient is going to lose an
anterior tooth and have an immediate
implant placed and provisionalized.
In the act of the surgical procedure
itself, the implant surgeon is focused
on the atraumatic extraction, being
careful not to damage the soft tissue
architecture, the removal of the tooth
and any granulation tissue. The
place­ment of the implant in the ideal
position and torqued to specifications.
If the surgeon takes time to evaluate
his or her feelings or to feel happy,
they could make a mistake. Only after
the task is completed do we have the
leisure to look back on what has
happened, and then we are flooded
with gratitude for the excellence of
that experience. Then, in retrospect,
we are happy.
When we are in flow, we are not
happy, because to experience happiness
JB White, DDS
we must focus on our inner states,
and that would take away attention
from the task at hand. The happiness
that follows flow is of our own making
and it leads to increasing complexity
and growth in consciousness.
Our profession of dentistry never
lacks clinical challenges and there are
always new skills to develop. We have
a boundless opportunity to experience
flow in our day-to-day lives. The
difficulty is establishing a practice
model that allows you the free­dom
from time and money to become fully
engulfed in your clinical experiences. ■
Figure 1: Csikszentmihalyi's flow model
Winter 2015–2016
25
NNDS Executive Director’s Message
W
Lori Benvin
[email protected]
“Happy Holidays
to you and your
family from
the NNDS!”
inter is upon us and it is a welcome sight to see snow again in draught ridden
northern Nevada. Our 2015–16 continuing education opportunities and special
events are underway. Please watch for our mailings, emails, eNewsletters, and
electronic faxes or check our website at www.nndental.org for all of our upcoming events.
Giving value to our members is important and we are continuing to offer lower prices for
our members and encourage non-members to join to also receive benefits.
It’s here and live! The new website for the Northern Nevada Dental Health Programs has
been launched—please go to www.nndhp.org and check it out. We are extremely proud of
our new branding and resources our new website offers. We also can be found on Facebook
at https://www.facebook.com/NorthernNevadaDentalHealthPrograms
Our 13th Annual NNDHP/Joel F. Glover Charity Golf Tournament concluded on Sept. 25.
With another successful event we will give $35,000 in net proceeds to the Adopt-a-Vet
Dental Program this year. The sustainability of both of NNDHP’s programs is the focus of
our annual golf tournament. We have incredible patient care staff members who work
tirelessly to coordinate dental care for our underserved children and low income veterans
from our generous dental providers. See page 29 for a list of our 2015 supportive
tournament sponsors who made this year’s golf event such a success.
Also this fall, two of our member offices participated in Dentistry From the Heart—
Dr. Stuart Labowe and Sala Family Dentistry. In total, volunteers saw 210 patients and
donated over $128,000 in pro-bono dentistry. Congratulations to both office teams for your
incredible free dental day.
We continue to offer outstanding continuing education coming to Reno in 2016 and 2017.
Check your email or our website at www.nndental.org and register online. If you are not
receiving our emails, contact our office at (775) 337-0296 or email [email protected]. ■
NNDS President’s Message
A
Brandi Dupont, DMD
26
NDA Journal
s the weather turns cold and we hope for snow in Northern Nevada, I want to thank
our members for supporting our programs and courses this past fall. We had a
wonderful turnout for the UNR vs. Arizona State tailgate party and football game
for the NNDS annual Spouse’s Night on Sept. 12. The Northern Nevada Dental Health
Program held its 13th Annual Joel F. Glover Charity Golf Tournament on Sept. 25 with all
proceeds benefitting the Adopt-a-Vet Dental Program. We also had three great continuing
education events during October and November covering dental ergonomics and pediatric
dentistry.
Looking forward to the coming months, in January the NNDS will be hosting an
informative “Vendor Night” where dentists and hygienists can attend, enjoy some hors
d’oeuvres, and catch up on the latest in dental technology. The Northern Nevada New
Dentist Committee Give Kids A Smile event is Saturday, Feb. 6 at the Community Health
Alliance. February brings a General Membership Dinner Meeting discussing the peer view
and disciplinary processes by John Hunt, Esq., attorney for the Nevada State Board of
Dental Examiners. And finally, in March, the NNDS is proud to announce that Dr. Lee
Ann Brady will be presenting on restorative dentistry topics.
We look forward to seeing members of our dental community at our upcoming events as
we hope to provide quality continuing education and opportunities to connect with
colleagues. Here’s to a healthy and Happy New Year! ■
Welcome to our new
NNDS members
Kurt J. Brockman, DDS General
Ryan Coombs, DDS General
Bradlee Davis, DDS General
Morrigan Drew, DDS General
Alyson Felesina, DDS General
Sara Hakim, DDS General
F. Jeremy John, DMD
Pediatric Dentistry
Catherine Kanwetz, DDS General
Michael P. Lund, DDS General
Jennifer Rearrick, DDS General
Garrett Swanson, DMD General
Kelli Weyrick, DMD General
Dallis Jacob Zurcher, DDS General
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Winter 2015–2016
27
NORTHERN NEVADA DENTAL
HEALTH PROGRAMS
Thanks the following for their generosity to the
13TH ANNUAL NNDHP/JOEL F. GLOVER
CHARITY GOLF TOURNAMENT
2015 Tournament Sponsor
Reno Tahoe Oral Surgery & Dental Implant Center
Scott M. Redlinger, DMD, MD
Major Sponsors
AAA
Patterson Dental / 3M ESPE
Bobcat Trust—Bob & Cathy Weise
ProAssurance
Orgill Singer Insurance
Universal Advisors
Special Contributors
Barone Imports
Pigeon Head Brewery
Nobel Biocare
Renown Health
Hole/Tee Sponsors
Contributing Donors
Boyden Oral & Maxillofacial Surgery, Inc.
Community Health Alliance
Henry Schein Dental
Mercedes Benz of Reno/AutoNation
Neoss, Inc.
Nevada Dental Association
OMS Associates; Myatt, Melendrez & Falke
Wells Fargo Bank
Chase Stigall/El Dorado Casino Resort
Cutting Image, LLC / Eric & Debbie DeWitt
Doughboy Donuts
Dr. and Mrs. Perry Francis
Francovich/Stoker Family & The Smile Shop
Golf Headquarters of Reno
HUB Coffee Roasters
Nothing Bundt Cakes
Scheel’s
Whispering Vine Wine Co.
Hole Sponsors
Mrs. Mary Glover
Miller & Trujillo Pediatric Dentistry
Daniel Muff, DDS, MD
Superior Dental Lab, Inc.
Breakfast Sponsor/Partner
Heritage Bank of Nevada
JOEL F. GLOVER, DDS
28
NDA Journal
REPORT
Admissions and Student Affairs
The 2015–16 application is underway.
We have received 1,739 applications so
far. The deadline to submit an AADSAS
application for the SDM is Jan. 1.
Interviewing began on Sept. 25. and
will continue until February/March.
UNLV ASDA held a food drive from
Oct. 12–29. Over 3,500 items were
collected and donated to Three Square
Food Bank in Las Vegas.
Advanced Education in Orthodontics and
Dentofacial Orthopedics Residency Program
The following Residents will graduate
on Dec. 15, 2015 with a Certificate in
Orthodontics and a Master’s of
Science in Oral Biology: Annie Hsu,
Brandon Streiff, and Brian Wilde.
Dr. James Mah, Dir. of Advanced
Education Program in Orthodontics
attended the 8th International Ortho­
dontic Conference held Sept. 27–30 in
London, England. Dr. Mah’s presen­
tation was titled “Novel Investigative
Tools in Forensic Sciences Using
Orthodontic Record Analyses.”
Office of Research
The UNLV SDM Dean’s Symposium
and 14th Student Research Day will
be held on Feb. 29, 2016. We are
honored to have Dr. Edward Lynch,
PhD, Lond, MA, BDentSc, TCD,
FDSRCSEd, FIADFE, FDSRCSLond,
FASDA, FICCDE, FACD, Head of
Dentistry in Warwick Dentistry,
Warwick Medical School Coventry as
our guest speaker and Student Research
Day Judge. Dr. Lynch will address
students, faculty, and community
guests on “Minimal Invasive Dentistry:
Using New Technologies to Permit
Faster, Easier and Better Clinical
Dentistry.” CE credit will be provided
free to all participants. For additional
information, please contact Noriko
Takeda at [email protected].
Faculty publications
Patricia Cruz, Mark Buttner, Theresa
Thrice, and Katherine Howard
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published an article, “Development of
Sciences. Last but not least, the SDM
welcomes Visiting Assistant Professor
a Polymerase Chain Reaction Assay
of Clinical Sciences Dr. Scarlett
for the Rapid Detection of the Oral
Hernandez.
Pathogenic Bacterium, Selenomonas
noxia.” BMC Oral Health, Aug. 2015.
Community Service Report
Marcia Ditmyer, PhD, MCHES,
Students and pediatric dental residents
Christina A. Demopoulos, DDS, MPH, continue to provide preventive services
and Connie Mobley, PhD, RD. “Oral
in community-based, underserved
Effects of Tobacco and Marijuana Use.” settings in Clark County and Nye
The Journal of Multidisciplinary Care
County. Services are offered at health
Decisions in Dentistry. October 6, 2015. fairs, career fairs, back to school events
and various other community-based
Faculty announcements
settings.
From Aug. 11–Nov. 7, 2015,
Dr. Connie Mobley was interviewed
we attended 23 events with 826
by the “Dallas Morning News” for an
participants. Twelve seniors, 71 adults,
article published Nov. 2 and quoted on
and 324 children were screened.
the “ADA Morning Huddle” regard­
Furthermore,
327 sealants were placed
ing trends in fad diets and the impact
on children. The total value for donated
on teeth. (Mobley, C. Fad Diets: Facts
services during this period was $23,408.
for Dental Professionals, JADA, 2009)
On Oct. 2–4, over 200 dental
Dr. Mobley and Canadian dental
professionals
and students from the
colleagues have been invited by the
SDM
and
the
College of Southern
American Association for Dental
Nevada joined with other medical
Research (AADR) to present a session
professionals at the Remote Area
on Oral Health and Aging: An Inter­
Medical
(RAM) event in Las Vegas.
professional Approach to Geriatric
RAM
is
a
non-profit international
Dentistry at the 2016 AADR Annual
organization based in Tennessee with
Meeting in Los Angeles, CA.
a sole mission to prevent pain and
Faculty news
suffering by providing free, quality
Dean Karen West officially became
health care to those in need. During
Chair of the Commission on Dental
the course of this event a total of
Accreditation of the ADA following
$277,431.39 in care (medical, dental
the ADA Annual Meeting in October
and vision) was provided. The break­
in Washington, DC. Dean West
down for dental services provided
recently returned from a speaking
included 200 extractions, 150 teeth
engagement at King Khalid University cleanings, and 100 fillings.
in Saudi Arabia on “International
Alumni news
Dimension of Dental Education.”
Congratulations to Dr. Robert B. Hale
We are pleased to welcome back
on being named SDM 2015 Alumnus
former faculty members Dr. Tanya
of the Year. Dr. Hale completed his
Al-Talib and Dr. Brian Chrzan to the
DMD degree in 2009 and is an
SDM. Dr. Al-Talib is an Assistant
endodontist residing in Salt Lake City.
Professor in Residence Clinical
Continuing Education
Sciences (Ortho) and Dr. Chrzan is a
Courses being offered by the UNLV
Visiting Assistant Professor in
SDM include:
Biomedical Sciences. We also wish to
• Dr. Michael Ragan, “HIPAA” Feb. 13.
congratulate Dr. Kristen Baca and
Dr. Richard Schoen on their transition
To register for courses or for more
from part-time instructors to Visiting
information on Continuing Education
at SDM, visit http://sdm.unlv.edu/ce. ■
Assistant Professors of Clinical
Winter 2015–2016
29
The Power of Three:
National, State and Local
Societies working together.
State
The ADA Organization is comprised
of the national, state and local
ADA
associations, all focused on:
Member
• Meeting member needs
• Solving member problems
National
Local
• Exceeding member expectations
The coming years will bring considerable change to the dental
profession, significant challenges, but also some new opportunities.
A Shared Vision for The Power of Three
“Power of Three” is a new tripartite initiative aimed at reversing the
national market share decline and positioning the tripartite for
ongoing growth. This collaboration has a greater chance of creating a
future in which our collective associations will be stronger and more
successful in helping all members succeed and, as a result, more
dentists will recognize a need to belong to our associations.
Together, we can build member value.
30
NDA Journal
NDA Calendar of Events
January–March 2016
JANUARY
Tue 12
NNDS Executive Committee Meeting & Delegate PreMeeting
5:45 pm
Wed 13
NDA Executive Meeting
6 pm
Video conference
Thu 14
NNDS General Membership / Vendor Night
6 pm
Atlantis Casino Resort Spa, Reno
Thu 21
SNDS Membership Dinner Meeting
Thu 21
AGD General Membership Dinner
6 pm
TBD
Sat 23
SNDS presents: New Dentist Social—Bowling
TBD
Red Rock Lanes
Sat 30
NDA MidWinter Meeting/House of Delegates
8 am
Springs Preserve, Las Vegas
5:30 pm
161 Country Estates Cir, #1B, Reno
Gold Coast Hotel, Las Vegas
FEBRUARY
Sat 6
Give Kids A Smile
Tue 9
NNDS Executive Committee Meeting
Thu 11
NNDS General Membership Dinner Meeting
“Peer Review & Disciplinary”
Thu 18
SNDS Membership Dinner Meeting
Thu 18
AGD Dinner Meeting
All day
Various locations
5:45 pm
161 Country Estates Cir, #1B, Reno
6 pm
Atlantis Casino Resort Spa, Reno
5:30 pm
6 pm
Gold Coast Hotel, Las Vegas
TBD
MARCH
Tue 8
NNDS Executive Committee Meeting
5:45 pm
Wed 9
NDA Executive Committee Meeting
6 pm
Video Conference
Thu 10
NNDS General Membership Dinner Meeting
with Dr. LeeAnn Brady
6 pm
The Grove Event Center, Reno
Fri 12
NNDS presents: All Day Continuing Education, with Dr. LeeAnn Brady
8 am
The Grove Event Center , Reno
Thu 17
SNDS Membership Dinner Meeting
Thu 17
AGD General Membership Dinner
6 pm
TBD
Wed 18
SNDS presents: CE Seminar with Dr. Ross Nash, “Esthetics and Cosmetic”
9 am
Gold Coast Hotel, Las Vegas
Thu 19
SNDS General Membership Dinner Meeting
5:30 pm
Gold Coast Hotel, Las Vegas
Thu 24
SNDS presents: New Dentist Continuing Education,
“Contract Negotiations and Panel Discussion”
5:30 pm
TBD
161 Country Estates Cir, #1B, Reno
Gold Coast Hotel, Las Vegas
TBD
Save the Date
Give Kids A Smile!
Saturday, February 6, 2016
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Winter 2015–2016
31
ADA-Affiliated Products
We are pleased to announce that the NDA
and ADA have combined the purchasing
power of dentists to gain discounts on a
large variety of products and services. Call
the company or the NDA to learn more.
CareCredit
Patient financing
800-300-3046 x4519 www.carecredit.com
InTouch Practice Communications
877-493-9003
www.intouchdental.com/ada
TDIC
Professional liability
800-733-0633 www.tdicsolutions.com
Wells Fargo Practice Finance
888-937-2321 www.wellsfargo.com/dentist
NDA-Affiliated Products
These companies and their products have
been evaluated by the NDA and are
recommended for use in running your
practice. Let us know if you have any
feedback or would like to recommend a
product or service for affiliation.
For a weblink to each company, go to
www.nvda.org/affiliatedproducts.shtml.
Best Card, LLC
Credit card processing
877-739-3952 www.bestcardteam.com
The Dental Record
Digital record keeping
800-243-4675 www.dentalrecord.com
EBSCO
Subscription service
800-527-5901 x1652 www.ebsco.com/errss
FedEx
Shipping services
800-636-2377 or 1-800-MEMBERS
Fletcher Jones Imports
Mercedes-Benz leasing
866-628-7232 www.ada.org/mercedes
HP (Hewlett Packard)
800-243-4675, mention ADA
www.hp.com/ada
IC System
Collection service
800-279-3511 www.icsystem.com/nda.htm
Land’s End Business Outfitters
Uniforms
800-490-6402 www.ada.landsend.com
Office Max
Office supplies
702-647-8662 www.officemax.com
SurePayroll
Payroll processing
866-535-3592 www.surepayroll.com/ada
UNLV School of Dental Medicine
Hands-on continuing education
702-774-2400 www.dentalschool.unlv.edu
Whirlpool Corporation
866-808-9274 www.partners.whirlpool.com
32
NDA Journal
NEVADA DENTAL ASSOCIATION
8863 W FLAMINGO RD, STE 102
LAS VEGAS, NV 89147-8718
CHANGE SERVICE REQUESTED