Volume 10 • 2023 • Issue 1

2023 • Volume 10 • Issue 1 The Canadian Dental Association Magazine Launch of the Canada Dental Benefit Page 9 PM40064661

CDABoardofDirectors President Dr. Lynn Tomkins Dr. Marc Mollot Manitoba CDAMissionStatement The Canadian Dental Association (CDA) is the national voice for dentistry dedicated to the promotion of optimal oral health, an essential component of general health, and to the advancement and leadership of a unified profession. is the official print publication of CDA, providing dialogue between the national association and the dental community. It is dedicated to keeping dentists informed about news, issues and clinically relevant information. Dr. Brian Baker Saskatchewan President-Elect Dr. Heather Carr Vice-President Dr. Joel Antel Dr. Mark Bochinski Alberta Dr. Dana Coles Prince Edward Island Dr. Viktor Dorokhine NWT/Nunavut/Yukon Dr. Stuart MacDonald Nova Scotia Dr. Bruce Ward British Columbia Dr. Jason Noel Newfoundland/Labrador Dr. Kirk Preston New Brunswick Dr. LouAnn Visconti Ontario 2023 • Volume 10 • Issue 1 Head of Communications Zelda Burt Managing Editor Sean McNamara Writer/Editor Sierra Bellows Gabriel Fulcher Pauline Mérindol Publications & Electronic Media Associate Rachel Galipeau Graphic Designer Carlos Castro Advertising: All matters pertaining to advertising should be directed to: Peter Greenhough Media Partners Inc. 15 Wade Road Ancaster, ON L9G 4G1 Display or web advertising: Peter Greenhough pgreenhough@pgmpi.ca 647-955-0060, ext. 101 Classified advertising: John Reid jreid@pgmpi.ca 647-955-0060, ext. 102 Contact: Rachel Galipeau rgalipeau@cda-adc.ca Call CDA for information and assistance toll-free (Canada) at: 1-800-267-6354 Outside Canada: 613-523-1770 CDA email: publications@cda-adc.ca @CdnDentalAssoc @JCDATweets @CDAOasisLive canadian-dentalassociation CanadianDental Association CDAOasis cdndentalassoc cdaoasis cda-adc.ca CDA Essentials is published by the Canadian Dental Association in both official languages. Publications Mail Agreement no. 40064661. Return undeliverable Canadian addresses to: Canadian Dental Association at 1815 Alta Vista Drive, Ottawa, ON K1G 3Y6. Postage paid at Ottawa, ON. Notice of change of address should be sent to CDA: reception@cda-adc.ca ISSN 2292-7360 (Print) ISSN 2292-7379 (Online) © Canadian Dental Association 2023 Cover Photo: Adam Scotti, Office of the Prime Minister Editorial Disclaimer All statements of opinion and supposed fact are published on the authority of the author who submits them and do not necessarily express the views of the Canadian Dental Association (CDA). Publication of an advertisement does not necessarily imply that CDA agrees with or supports the claims therein. The editorial department reserves the right to edit all copy submitted to CDA Essentials. Furthermore, CDA is not responsible for typographical errors, grammatical errors, misspelled words or syntax that is unclear, or for errors in translations. Sponsored content is produced by Peter Greenhough Media Partners Inc., in consultation with its clients. The CDA Essentials editorial department is not involved in its creation. 3 Issue 1 | 2023 |

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Contents The Canadian Dental Association Magazine 2023 • Volume 10 • Issue 1 18 20 23 29 CDA atWork 7 Greater Equity in Dentistry 9 Launch of the Canada Dental Benefit 13 CDAnet Standard 2.4 to Retire in 2024 News and Events 14 Abacus Survey Focuses on People Eligible for CDB Program 17 Dr. LynnTomkins Receives PFA Award 17 WHO Publishes Global Oral Health Status Report Issues and People 18 Environmental Impact of PPE 20 Making a Dental Office Carbon Neutral 23 Dr. Sheri McKinstry: Community Advocate and Inspiration Classifieds 34 Offices and Practices, Positions Available, Advertisers’ Index Supporting Your Practice 29 How to Manage Root Perforations 32 Putting Anger in its Place: Strategies for Understanding and Managing Anger Obituaries 38 Dr. Claude Remise 5 Issue 1 | 2023 |

The best part? We are with you every step of the way providing education, dedicated support, clinical guidance, and practice integration assistance. Visit invisalign.ca/provider to learnmore 1 *Basedon a survey of n=378U.S. InvisalignOrthodontists (Advantage tier Silver and above) who agreed that usageof Invisalign clear aligners allowsme to increase intervals betweenpatient visits. Theywere then asked “howmuchdo you agreeor disagreewith the following statement: Usageof Invisalign clear aligners allowsme to increasemy intervals between patient visits andbecauseof this I have increasedmy profitability per patient visit.” Data on file at AlignTechnology, as of December 1, 2018. 2 Basedon a survey of n=100USandCanada Invisaligndentist active submitters (1+ casepast 12months) who agree that they have successfully integrated Invisalign clear aligner therapy into their practice. Theywere asked to indicate their level of agreement with the statement “I havebuilt greater trust with patients treatedwith Invisalign clear aligner therapy.” Data on file at AlignTechnology, as of January 10, 2020. 3 Basedon a survey of n=100USandCanada Invisaligndentist active submitters (1+ casepast 12months) who agree that they have successfully integrated Invisalign clear aligner therapy into their practice. Theywere asked to indicate their level of agreement with the statement “Adding Invisalign clear aligner therapy tomy practice increased the number of newpatients.” Data on file at AlignTechnology, as of January 10, 2020. 4 *Gu, J et al. Evaluation of Invisalign treatment effectiveness andefficiency comparedwith conventional fixed appliances using thePeer Assessment Rating index. AmJOrthodDentofacial OrthopFebruary 2017;151:259-66 ©2023 AlignTechnology, Inc. All RightsReserved. Align, theAlign logo, Invisalign, the Invisalign logo, iTero, iTeroElement, andClinCheck, amongothers, are trademarksand/or servicemarksof AlignTechnology, Inc. or oneof itssubsidiariesor affiliatedcompaniesandmaybe registered in theU.S. and/or other countries. |MKT-0003397RevB Invis is imagining the possibilities Offering Invisalign® treatment has helped doctors like you benefit from: Increase in new patients3 Shorter treatment times compared to braces4 Increased profitability1 Improved patientdoctor relationships2 I i i imagining the po sib lities

Dr. Lynn Tomkins president@cda-adc.ca Greater Equity inDentistry When I was in dental school at the University of Toronto, I was one of 20 women in a class of 120 and most of us came from similar socio-economic, racial and ethnic backgrounds. In 1980, as the CDA Student Governor, I became the first woman to sit on the CDA Board of Governors, now called the CDA Board of Directors. As the Canadian population has become more socially, culturally, racially and ethnically diverse over the last 40 years, the diversity of dental students has also increased dramatically. Currently, about half of all students at Canadian dental schools are women. Unfortunately, diversity among the leadership in our professional associations has lagged. In 2008, Dr. Deborah Stymiest became CDA’s first woman president in its history. I’m now the second woman to serve as CDA president and Dr. Heather Carr will begin her tenure as CDA president this April. Why does it matter that the leadership of our professional organizations in dentistry become more diverse? I believe that the survival of our organizations depends on it. People join associations because they want to be a part of something that they can identify with, something that reflects their own values and aspirations. We need to foster the emotional ties that will keep dentists connected, engaged and active throughout their careers. If dentists don’t see themselves reflected in the leadership and culture of our organizations, they won’t be engaged. Membership in organizations predicated on exclusive access to services is transactional in nature; a competitor with a better deal can lure members away. Loyalty comes from a sense of belonging, a feeling of shared experience and vision for the future. I think we can do a better job of seeking out and mentoring future leaders of all genders and backgrounds and encourage them to put their names forward for leadership roles. We should help them develop the skills and confidence that will take them on the path to leadership. We should actively work to be inclusive and reflect the diversity of our country and profession. We must stay relevant in a fast-changing and competitive environment. Recently, I’ve been considering the larger implications of diversity and equity in a world where so many people suffer because of discrimination and intolerance related to their gender, sexual orientation, disability, age, race or ethnicity. In the news, we see women persecuted in some countries because of their clothing choices. We see ethnic groups forced to flee their homes in fear of violence. Equity can only exist when human rights are respected. As a health care provider, I also reflect on our moral responsibility to speak out against human rights abuses. As a dentist, my main concern is people’s oral health, but health and well-being is impossible if human rights are infringed upon. I see an opportunity for dentistry to expand its area of influence to defend health and human rights and to demonstrate our care not just for teeth, but for people and communities. Ending on a personal note, I would like to ask those reading this column to consider the following: What is the responsibility of an individual dentist, as a university-educated citizen and leader in the community, to speak out on the wider issues of social justice and human rights? What is the responsibility of the organizations that represent dentistry to do likewise? If we are to achieve true diversity, equity and inclusivity in this world, I believe we have an obligation to speak out and speak up whenever we encounter injustices at home or abroad. From the President 7 Issue 1 | 2023 | CDA atWork

Launch of the Canada Dental Benefit The Canada Dental Benefit (CDB), an interim measure to provide direct, up-front, tax-free payments to offset out-of-pocket dental care expenses for Canadian children under age 12 in low-income households, formally launched on December 1, 2022. To mark the launch of the CDB, Dr. Lynn Tomkins, CDA president, joined Prime Minister Justin Trudeau and Karina Gould, Minister of Families, Children and Social Development, at an event at Western University’s Schulich School of Dentistry in London, Ontario. “Oral health is an essential component of overall health,” said Dr. Tomkins. “Visiting the dentist early and regularly is an important way for a child to get started on their journey to a lifetime of good oral health. Thanks to the Canada Dental Benefit, more children across Canada will get access to the dental care they need to have healthy teeth, mouths, and smiles.” “Many children in low-income households are not getting the dental care they need. But as parents, we recognize that dental care is an essential part of children’s health and wellbeing. Our government has always been Dr. LynnTomkins, CDApresident, with PrimeMinister JustinTrudeau, wearing the official CDA tartan scarf, designed byDr. CarolMartin. Photo: AdamScotti, Office of the PrimeMinister 9 Issue 1 | 2023 |

committed to families, and today we’re delivering real change with the launch of the Canada Dental Benefit,” said Prime Minister Trudeau. That same day, Dr. Aaron Burry, CEO of CDA, joined Jean‑Yves Duclos, Minister of Health, and Diane Lebouthillier, Minister of National Revenue, at another launch event held at a pediatric dental office in Ottawa. “CDA welcomes today’s launch of the Canada Dental Benefit,” said Dr. Burry. “As the federal government moves forward with its historic investment in enhancing access to dental care, we look forward to collaborating with them on this and future initiatives.” The CDB will provide payments up to $650 per child per year for families with adjusted net income under $90,000 per year and without dental coverage. Parents or guardians of eligible children must apply to receive the CDB through the Canada Revenue Agency’s My Account portal. Children are eligible to receive one CDB payment for dental services received in each of two eligibility periods: October 1, 2022, to June 30, 2023, and July 1, 2023, to June 30, 2024. Future phases of the federal government’s approach to enhancing access to dental care will expand to include children under age 18, seniors, and persons with disabilities by the end of 2023, and all other adults by 2025. In 2023, Dr. Tomkins notes that CDA will focus on priority areas related to the federal commitment to invest in access to dental care. “We will continue to serve as the national voice for dentistry and ensure that oral health care remains a recognizable and significant public health issue,” she says. “As well, we’ll help shape the government’s dental care policy development and the design of future federally funded dental care proposals.” Visit the CDA website for more details and updates on the CDB: bit.ly/3CInxyC Members of Western University’s Schulich School of Dentistry demonstrating dental tools and techniques to young patients at the December launch event. 10 | 2023 | Issue 1 CDA atWork

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CDAnet Standard 2.4 to Retire in 2024 Version 2.4 of the Message Formats and Standards for Electronic Dental Claims for CDAnet & Réseau ACDQ, also known as the CDAnet Standards, will be retired effective February 1, 2024. Published in 1990, the CDAnet Standard 2.4 has made it possible to transmit dental benefit claims electronically. The version was the start of significant changes that paved the way to today’s version 4.2. Claims processors primarily use CDAnet Standard version 4.2 to process claims. Therefore, only a limited number of claims processors will be required to upgrade their systems before the February 2024 deadline. As the claims processors upgrade their systems, dental offices will need to configure their practice management software to send claims using only version 4.2. “We are excited for the changes that retiring version 2.4 will bring to claims processing in Canada for all the CDAnet community (dentists, claims processors, vendors, denturists and hygienists, etc.) and the Réseau ACDQ community (dentists in Quebec, vendors, claims processors, etc.),” says Donna Cunningham, CDA Practice Support Services advisor. The additional benefits of version 4.2 include: Save time and money Dental software vendors will no longer need to develop software for both versions. Claims processors will have fewer variables to account for when developing their systems. Increase coordination of benefits claims Retiring version 2.4 simplifies a number of aspects related to coordination of benefits (COB). With dental offices having version 4.2 configured for all claims processors, opportunities to send a COB will not be missed. Many claims processor systems cannot currently accept version 2.4 explanation of benefits (EOB) in a COB claim, but this limitation was resolved in version 4.2. Dental offices will be able to send more COB claims for their patients, increasing claims for existing COB claims processors, and claims processors who invest in adding the COB transaction will also see a quicker return on investment. More opportunity for attachment transactions Claims processors upgrading to version 4.2 will have the opportunity to accept the CDAnet Attachment message for their members. This will increase efficiencies for both the dental office and the claims processor. Data accuracy All claims traffic will be in version 4.2. Dental practice management software will have updated claims processor information, which will result in claim messages and claim responses no longer requiring any version translation. Streamlined support Networks and insurance carriers will only need to support version 4.2 systems and processes. CDA and the ACDQ will be working with the CDAnet community to ensure a smooth transition to the new version. More communications will be provided as new information becomes available. 13 Issue 1 | 2023 | CDA atWork

Support for federal investment in dental care since August 2022 survey Intend to use the new dental benefit Abacus Survey Focuses on People Eligible for CDB Program In a public opinion survey conducted in fall 2022 on behalf of CDA, Abacus Data looked at how Canadians reacted to the announcement of theCanadianDental Benefit program(CDB), especially parents of children under age 12 with household incomes less than $90,000, the segment of the Canadian population targeted in phase one of the CDB initiative. The survey also included some pandemic-related questions for tracking and comparison purposes. But this time around, Abacus Data oversampled Canadian parents of children under age 12 who are eligible for the CDB to get a better sense of the public’s reaction to the program. Almost 3,500 people were surveyed in fall 2022, focusing on the proposed federal investments in dental care, details on dental insurance and additional dental coverage, trends in Canadians’ behaviours towards dentistry, and on the impact of inflation (particularly on families with children under age 12) and healthy eating habits. Even though 63% of Canadians have heard about a proposed federal government investment in enhancing access to dental care (up 7% points from August), less than half of Canadians (49%) had heard of its first phase. Only 50% of families who meet program criteria had heard about the CDB program or think they have. • Support for the CDB program after details are described (e.g., targeting households with less than $90k household income, don’t currently have a dental plan, etc.) dropped by 7% points, to 70% of the Canadian public. • After hearing new details about the first phase of the proposed federal investment in dental care, slightly fewer Canadians (57%) support the specific approach the federal government has taken with the CDB. • Parents with children under 12 in households earning less than $90,000 per year have developed a broader support of the initiative (75%). After hearing about the CDB program criteria and details, 70% of Canadians whose families meet those requirements say they are planning to apply to receive the dental benefit for their children. • 68% say they would be more likely to bring their children to the dentist because of the CDB. • 7 in 10 think this first phase of the proposed program will help relieve some financial pressure on annual dental expenses for their children. • Almost 75% feel that the proposed plan is enough to help families in Canada access dental care and most (83%) feel the proposed federal investment will lead to improved access to dental care. 14 | 2023 | Issue 1 News and Events

Canadian economy and the impact of inflation Although the current economic situation worries most Canadians (80%), only 2 in 10 Canadians say they are living “beyond their means.” But some report living “paycheque to paycheque” (51%) rather than comfortably. “Two-thirds of eligible families say they’re more likely to go to the dentist because of this CDB benefit,” and 70% say they plan to apply for the benefit, says David Coletto, CEO of Abacus Data in a CDA Oasis interview. “There’s already widespread awareness among that core audience that this benefit is starting to have a clear impact. The challenge is that half of those who are delaying dental appointments are doing so because they’re waiting for the implementation of the CDB plan,” says Coletto. • 36% of families eligible for the CDB have delayed going to a dental appointment because they were waiting for the implementation of the federal dental plan. And of these families waiting, almost 50% would be delaying care until they actually get funds deposited in their account. • Among those who have not been to the dentist for some time, the top reason remains the high cost—up 5 points from the August survey. And those who are currently delaying a dental appointment for their child because of cost has increased by 7 points since August (22% are currently delaying). • Almost one-third (35%) wouldn’t be able to afford regular dental care each year if they lost dental coverage (down 6 points since August). • A similar percentage (35%) say they will be delaying further dental appointments due to the current economic situation—up 8 points from August. For most families, their children’s dental care needs are more accessible, but not affordable: • About half of parents of CDB-eligible families currently visit the dentist with their children on a regular basis • For a quarter of people (24%), long wait times for an appointment/availability is the main reason for having difficulty accessing dental care, up 7% points since August. “We’ve seen an increase in our tracking around the number of parents citing long wait times for being able to get appointments with dentists. So cost is a primary driver but not being able to access care is also something we’ve seen,” says Coletto. “Two out of three Canadians agreed that children’s access to activities, hobbies, nutritious food, even sports and exercise has been negatively affected by the pandemic. And one in three of respondents say they will be delaying further dental appointments due to the current economic situation. So, if you look at this sort of broad impact, it’s affecting people’s ability to access or afford dental care,” he concludes. The survey was conducted with 3,500 Canadians from September 29th to October 15th, 2022. This wave, n=1250 Canadians who are parents of children under 12 with household incomes under $90,000 were oversampled. A random sample of panellists were invited to complete the survey from a set of partner panels based on the Lucid exchange platform. These partners are typically double opt-in survey panels, blended to manage out potential skews in the data from a single source. The margin of error for a comparable probability-based random sample of the same size is +/-1.63%, 19 times out of 20. The data were weighted according to census data to ensure that the sample matched Canada’s population according to age, gender, educational attainment, and region. Totals may not add up to 100 due to rounding. Watch an interview with David Coletto, CEO of Abacus Data, on CDA Oasis: bit.ly/3UWbHYv 15 Issue 1 | 2023 | News and Events

As a dentist, you understand the value of a regular dental checkup. It’s true for your finances as well. Your ability to achieve healthy financial outcomes can be impacted by the passage of time or a milestone such as: Starting or buying a practice Getting married or divorced Welcoming a new member to your family Buying a vacation home or income property Receiving an inheritance Selling your practice Retiring Plan More and Worry Less. Book your checkup today. Is it Time for a FINANCIAL CHECK-UP? 1.800.561.9401 cdspi@cdspi.com One of the benefits of dental association membership is a complementary financial checkup with an Advisor at CDSPI Advisory Services Inc.

Global oral health status report Towards universal health coverage for oral health by 2030 Global oral health status report Towards universal health coverage for oral health by 2030 In October 2022, the Pierre Fauc ard Academy (PFA) conferred the Elmer S. Best Award upon Dr. Lynn Tomkins, CDA president, at a ceremony in Houston, Texas. The award is the PFA’s pinnacle honour for dentists who reside outside the United States who have made distinguished contributions of international significance to dentistry. Dr. Tomkins is the first woman to receive this award since its introduction in 1962. A BSc a d DDS graduate of the University of Toronto (U of T), Dr. Tomkins was the first woman to serve on the CDA Board of Governors as the U of T representative of CDA’s Council on Student Affairs in 1980. She has been a clinical instructor in the department of oral diagnosis and oral medicine at U of T’s faculty of dentistry, where she received the Dr. A. Bruce Hord Master Teaching Award for excellence in clinical teaching in 2006. In 2015, Dr. Tomkins was appointed to the CDA Board of Directors and served on several committees and working groups to advance the dental profession and the oral health of Canadians before becoming CDA president in 2022. Dr. Tomkins is leading the organization in its mandate as the national voice for dentistry, dedicated to the advancement and leadership of a unified profession and to the promotion of optimal oral health as an essential component of general health. Dr. LynnTomkins, CDApresident (r.), receiving the Elmer S. Best Award fromDr. Lisa Bentley, PFACanadianTrustee and ODApresident (l.). In November 2022, the World Health Organization (WHO) released its Global Oral Health Status Report (GOHSR) offering a comprehensive look at the burden of oral disease and outlining the challenges and opportunities to make progress on the WHO’s goal of universal coverage for oral health by 2030. The report includes detailed oral health profiles (e.g., statistics, maps, graphics) and oral disease comparisons between countries, with the latest available data from the Global Burden of Disease project, the International Agency for Research on Cancer and other global WHO surveys. It emphasizes the global impact of oral disease on health and well-being and highlights inequalities, with a higher disease burden for the most vulnerable and disadvantaged population groups within and across societies. The GOHSR is part of the WHO’s series of data reports and is part of the larger process of mobilizing political action and resources for oral health. In 2022, the World Health Assembly adopted a global strategy on oral health with a vision of universal health coverage for oral health for all individuals and communities by 2030 and a detailed action plan is under development to help countries translate the global strategy into practice. WHO Publishes Global Oral Health Status Report The WHO Report is available at: bit.ly/3CU6ycJ Dr. Lynn Tomkins Receives PFA Award 17 Issue 1 | 2023 | News and Events

Dr. Brett Duane and his co-authors in the United Kingdom had questions about the environmental impact of this increase and how different types of PPE compared when considering environmental sustainability. “My research team is a collection of specialists, students, and colleagues interested in understanding the life cycle assessment of products,” says Dr. Duane. “In the past few years we’ve modeled and published life cycle assessments of seven different health care and oral health care products including examination kits, hand sanitizer and dental procedures.” Environmental Impact of PPE The COVID-19 pandemic changed safety guidelines for personal protective equipment (PPE) in dentistry, significantly increasing the amount of PPE used in dental practices. To meet the increase in PPE demand, the World Health Organization called for a 40% increase in PPE manufacturing in the early months of 2020. Dr. Brett Duane is an associate professor of dental science at Trinity College Dublin. He will be speaking at the Ontario Dental Association Annual Spring Meeting, May 11–13, 2023 (asm.oda.ca). Dr. Duane is a regular contributor to the British Dental Journal and one of the leading researchers in environmentally sustainable dentistry. 18 | 2023 | Issue 1

The researchers divided PPE into three categories: body protection, eye protection and respiratory protection. They used openLCA software to analyze and compare life cycle assessments of different kinds of gowns, visors, respirators and surgical masks. A life cycle assessment measures environmental impact at all stages of production, use and disposal across 13 categories. The group published its findings that showed that environmental impact varies based on PPE materials, country of origin, method of transportation and disposal process.1 They suggest that their study results can help inform dental clinics’ future PPE procurement decisions. The study concludes that the environmental impact of PPE could be reduced through using less damaging domestic products and increased use of reusables. “The selection of PPE that are reusable and made of recyclable materials can help to minimize the environmental impact and reduce environmental resource depletion,” the study says. The authors also suggest that the health care sector could require that PPE be made of recyclable materials, especially for large products such as gowns. Old reusable gowns could also be recycled to make new ones. “I’m particularly interested in how to make health care systems environmentally sustainable and, in turn, reduce population harm,” says Dr. Duane. “Much of my work involves evaluating different types of health care in order to find the system that provides optimal healthcare with the least environmental impact.” Reference: 1. Almutairi W, Saget S, Mc Donnell J, Tarnowski A, Johnstone M, Duane B. The planetary health effects of COVID-19 in dental care: a life cycle assessment approach. Br Dent J. 2022;233(4):309-16. The selection of PPE that are reusable and made of recyclable materials can help to minimize the environmental impact and reduce environmental resource depletion. 19 Issue 1 | 2023 | Issues and People

Making a Dental Office Carbon Neutral When Scott Andersen and his partners established Artisan Dental in Madison, Wisconsin, in 2014, they incorporated a range of energy saving strategies right from the start. “We purchased Energy Star appliances and computers,” says Andersen. “We installed motion sensing light switches in rooms. We chose a facility with an abundance of natural daylight with south-facing exposure.” Each year, Andersen and the dentists at the practice (including his spouse Dr. Nicole Andersen) meet to set new strategic goals for the practice. “In our mission statement, we set out to create health and happiness for five different stakeholder groups; our patients, team members, suppliers and contractors, local and global community and the environment,” he says. “We consider the environment to be a stakeholder in our practice because it provides our business with necessary inputs. Clean air, clean water, and nutrient rich soil.” One year, the environmental goal was to purchase 100% of the practice’s electricity from renewable sources. “That reduced Scott Andersen is the co-founder and director of stakeholder stewardship of ArtisanDental, a Certified BCorporation in Madison,Wisconsin. The multi-step process that one dental practice used to become environmentally sustainable 20 | 2023 | Issue 1

our carbon footprint by 83%,” says Andersen. “And we just had to make a phone call to our local utility and made the switch to their renewable energy option.” For the 4,000+ square foot practice, the switch to renewable energy costs an additional $1,200 a year. “We were very happy that a 83% reduction cost relatively so little. We put a sign up at our front desk that said, ‘Your care powered by the sun and wind.’” Andersen says that if a local utility doesn’t offer a renewable option, then renewable energy credits might be a good alternative. Southeastern US. “Landowners who have marginal farmland that would otherwise be unused and empty, they plant hundreds of trees per acre, and those trees pull carbon out of the atmosphere,” he says. “I get excited thinking about how in a few years, those trees will create a brand new ecosystem filled with birds and insects. Forests are also great filters of toxic materials, such as pesticides and fertilizers, that can harm rivers. There are so many ecological benefits.” Staff commuting to the dental practice by car contributed significantly the office’s carbon footprint, so the group decided to offer a small daily subsidy to employees who chose alternative transportation. “Now some of our colleagues bike, carpool or drive electric vehicles to work,” he says. Andersen has also looked for suppliers that offer carbon neutral shipping. He also talked to his long-time dental suppliers and made efforts to have fewer, larger shipments that saved on transportation costs and emissions. Their next big goal was to become carbon neutral. “We hired a consultancy company to measure our various emissions, and then to give us an aggregate measure of our carbon utilization,” he says. To measure the carbon use of the practice, Andersen shared information about which products the practice purchases, how much of each product and where the manufacturers are located. He also shared information about how the practice was heated and cooled, along with electricity and water use. The process also required gathering information about any travel for continuing education and employee commutes. “In fact, I remember them calculating the carbon footprint associated with items such as small gauze pads!” Andersen says. Once the practice knew how much carbon it was releasing each year, it could calculate how much it would need to spend to offset that amount. With help from the consultancy, Andersen considered several carbon-offsetting providers and decided to buy carbon credits from a company in the Dr. Nicole Andersen and Scott Andersen founded ArtisanDental in 2014 and transformed it into a carbon neutral practice. We consider the environment to be a stakeholder in our practice because it provides our business with necessary inputs. Clean air, clean water, and nutrient rich soil. Issues and People

PREVENTIVE RESTORATIVE COSMETIC 100% Your care - powered by the SUN & WI ND Enacting our mission to use sustainable business practices. comes from renewable sources through MG&E’s “Green Power for Tomorrow” of our electricity You can learn more about the Green Power Tomorrow program at www.mge.com/environment Recently, Artisan Dental decided to offset 20% more carbon that it produces. “I think of it as pulling down carbon that we produced years ago,” Andersen says. He feels that becoming carbon neutral has helped build relationships with patients and teams members. “Caring about the environment is a value that we share. It brings us together.” What’s next? “I want to talk to others in the dental community about how going carbon neutral creates benefits, both in the short- and long-term,” Andersen says. “I’m excited for the time when taking responsibility for our carbon emissions goes to scale and becomes a norm. The tools are out there and the process is getting easier every year.” To learn more about achieving carbon neutrality in a dental practice, contact Artisan Dental at scottandersen@tds.net Sign displayed at the front desk. 22 | 2023 | Issue 1 Issues and People

Community Advocate and Inspiration Dr. Sheri McKinstry’s Extraordinary Career Serving the Oral Health Needs of Indigenous Communities Dr. Sheri McKinstry—a dentist, an academic, an Anishinaabekwe from Treaty 1 territory, and a proud member of Sagkeeng First Nation in Manitoba— was not a typical student. Rather, she turned out to be an exceptional one. Though she was a strong student when she was a teenager, Dr. McKinstry dropped out of school to help care for her younger siblings. It was only after she met her husband and was expecting her first child that she began taking courses to complete her high school diploma. “I was very motivated because my husband and I wanted to provide opportunities for our children, opportunities that I didn’t have growing up,” Dr. McKinstry says. When it was time to contemplate her career possibilities, Dr. McKinstry and her husband sat down and talked about what she most wanted to do. “I had to decide, where am I going and what am I going to do?” she says. Dr. Sheri McKinstry 23 Issue 1 | 2023 | Issues and People

dentist and insisted that she didn’t want to specialize. This decision was due, in part, to the time commitment it takes, but also because she perceived specialization as something that was out of her reach. Practising in First Nations Communities After she earned her dental degree, Dr. McKinstry began practising dentistry with the First Nations and Inuit Health Branch (FNIHB) serving rural First Nations communities. Fortunately, Dr. McKinstry had family connections with some of the communities. “I initially provided dental services to Koostatak/Fisher River, Kinonjeoshtegon/Jackhead and HollowWater in 2005,” Dr. McKinstry says. “My biological paternal grandmother originated from Fisher River, and my grandfather’s family was originally registered with Peguis. While some of my family is still registered with Peguis, my dad, myself and my siblings are registered with Sagkeeng First Nation. My mom’s maternal and paternal side of the family is from the Bad Throat/Manigotagan area. Sadly, we don’t know much of the origins of her biological paternal family,” she says. “In addition to the original three communities, I picked up other First Nations communities over the years, but Fisher River and Jackhead are where I spent much of my dental career. They are amazing communities with beautiful people.” For the first six years of her career, Dr. McKinstry would drive to and from the communities where she provided dental services each day so she could be home with her family in the evenings. Then for the last six years, she spent the week in the communities where she worked and came home on the weekends. She heard stories about people’s difficult experiences with the medical system and the oral health system. “Which, of course, I wanted to fix,” she says, “in whatever way I could.” Dental School in Manitoba At the University of Manitoba (U of M), Dr. McKinstry qualified for a program that provided support for Indigenous students. “This program was my lifesaver,” Dr. McKinstry says. “It helped me navigate a system, the university, that was completely novel to me.” When her daughter was in first grade, Dr. McKinstry was in her first year of dental school. “My daughter would tell me that I was in grade one of dentistry, so we were in the same situation,” she says. While in dental school, Dr. McKinstry focused on getting her work done while raising four children. “I felt very privileged to be there,” she says. “I was in disbelief sometimes that I was at university, especially in dentistry, because of my childhood and background.” She didn’t have time to socialize much, but she says her classmates were supportive. Dr. Charles Lekic, who was the programdirector of pediatric dentistry at the U of M, became Dr. McKinstry’s mentor. “He was our class advisor and took care of all of us during those four years,” she says. “I think he tried to influence all of us to become pediatric dentists.” She planned to be a general Dr. McKinstry after receiving her Masters of Public Health in 2017. I was exploring what it meant to me to be First Nation. I wanted to know why my life as a child was so different from the lives of other Canadians. 24 | 2023 | Issue 1 Issues and People

The Intersection of Settler and Indigenous Cultures After working in the communities for seven years, in 2012, Dr. McKinstry began a part-time BA degree with a major in native studies and minor in sociology. “I was exploring what it meant to me to be First Nation,” she says. “I wanted to know why my life as a child was so different from the lives of other Canadians.” As well, she had questions about the impact that she was having in the communities where she worked. When she started out, she wanted to contribute to positive oral health changes in the lives of her patients, but, over the course of several years, she felt that she was failing the communities. “I wondered why I couldn’t make a difference in the community. I was still referring children off-site for surgery at hospitals,” Dr. McKinstry says. When she had the opportunity to complete a masters in public health specifically focused on Indigenous Peoples Health at the University of Victoria, (UVic) she took it, and put the BA on hold. “It was less part of my educational journey than my personal one,” she says. “Indigenous history in Canada was one of the biggest lessons that I needed to learn. My father was involved in a residential school, but he never talked about it. I feel that his and his siblings’ experience in the residential school system had a huge impact on my childhood, and contributed to the lack of opportunities that my family had, especially after my grandfather served in the army during WWII.” During her time at UVic, where she did research on cultural safety and reconciliation in dentistry, Dr. McKinstry began to feel more strongly that the most effective way for her to help Indigenous communities was to work with children. “I’d always loved interacting with children anyway, it was where my heart always was,” she says. When Dr. Lekic suggested that she attend the masters in pediatric dentistry at the U of M, as he did every year, Dr. McKinstry said yes in 2017. Dr. McKinstry’s thesis was related to the oral health experience of First Nations children requiring treatment under general anesthesia for early childhood caries. “My research was founded on qualitative research, specifically grounded theory. It happened to be the first qualitative research study to be successfully completed for the Master of Dentistry pediatric program at the U of M, thanks to my supervisors, Dr. Andrew Hatala and Dr. Robert Schroth,” she says. “And in many ways it validated what we already knew from existing research, and from working in communities for 12 years.” The study’s findings were that there were many access to care issues in First Nations communities in Manitoba. For example there was no dentist available in the community, or the dentist was too busy to see everyone that needed to be seen during their short time in the community. It also found that access to oral hygiene aids was a barrier to oral health because toothpaste and toothbrushes were expensive or difficult to obtain. Dr. McKinstry says that she asked about fluoridated water as part of her research. “And then later, I realized that some of the families I was interviewing had water delivered to their homes and stored in cisterns or kept water in buckets,” she says. “Further research revealed that some of the communities in Manitoba can go for days or weeks without water. Lack of fluoridation was the least of their concerns.” Importantly, her research findings touched on Indigenousspecific racism in dentistry in Canada. “This is relevant in contemporary Canadian health care, as professionals, we have come to learn following the tragic death of Joyce Echaquan that Indigenous-specific racism is embedded in all aspects of health care from Canada’s deep roots of colonialism,” Dr. McKinstry says. Echaquan, a member of the Stepping out of the clinic at the University of Manitoba. 25 Issue 1 | 2023 | Issues and People

Atikamekw Nation, died in 2020 at a hospital in Quebec, but not before she had recorded footage of hospital staff making racist remarks towards her. After an inquiry, the Quebec Coroner concluded that racism and prejudice were contributing factors to Echaquan’s death. The Role of Protector Dr. McKinstry took on an academic position teaching and doing research into oral health and public policy, as well as clinical subjects, at the University of Saskatchewan, which she did for almost two years before parting from the university setting. In her position as a professor, her goals were the same as they’ve always been. She wants to use her knowledge and expertise to benefit First Nations children and communities. Dr. McKinstry’s children have grown into young adults. “I worried at times that my obvious struggles throughout my academic journey would discourage my children from higher education,” she says. “This worry was put at ease as my children went on to complete programs in college and university. In fact, my daughter is currently in a Masters of Public Health program.” In 2021, Dr. McKinstry and Natasha Newman founded the Indigenous Dental Association of Canada to improve Indigenous oral health with the support of Indigenous and non-Indigenous oral health providers, while respecting traditional ways of knowing. Back in the late 1990s, Dr. McKinstry learned her traditional Indigenous name, Wabishki mitadim ojichidaa ikwe, which means White Horse Warrior Woman, during a ceremony with Elder Jules Lavallee at Red Willow Lodge. “Receiving my traditional name is something I had been longing for without knowing it. We had lost our culture,” she says. “When my name and the responsibility that came with my name was told to me in ceremony, everyone gasped. It was explained that my name came with the responsibility to protect those who needed to be protected,” she says. “It is a huge responsibility, and it is a responsibility that I take quite seriously.” Dr. McKinstry was given the Anishinaabe name Wabishki mitadim ojichidaa ikwe, which can be translated as White Horse Warrior Woman. I realized that some of the families I was interviewing had water delivered to their homes and stored in cisterns or kept water in buckets. Lack of fluoridation was the least of their concerns. 26 | 2023 | Issue 1 Issues and People

Learn more about the Indigenous Dental Association of Canada at: www.idac.agency Indigenous Dental Association of Canada The Indigenous Dental Association of Canada (IDAC) brings together the Indigenous dental community to support its vision of reconciliation. It provides Indigenous dental professionals with a community through which they can share resources, knowledge and experiences,while supporting approaches to oral health rooted in traditional ways of knowing. The association’s Indigenous Oral Health Knowledge Transfer Project will create tools and resources for communities to improve oral health. It will include a multimedia project to raise awareness about oral health care and services in Indigenous communities. As well, it will bridge cultural understanding and combat racial biases in oral health care. “Importantly, while IDAC endeavours to support oral health providers, researchers, and affiliates to move forward on our reconciliation journey, our priority is to create a culturally safe community for Indigenous oral health providers, Indigenous students interested in the oral health profession, and Indigenous communities,” says Dr. McKinstry. IDAC’swork contributes tosafer,culturally-informeddental services for Indigenous Peoples, while also creating a network of Indigenous dental professionals from across the country. A $1 million grant from Indigenous Services Canada is supporting IDAC’s work for the next two years. In Budget 2021, the Government of Canada committed to take action to foster health systems free from racism and discrimination where Indigenous Peoples are respected and safe. “This is part of the larger work that must be done to ensure that Indigenous Peoples have access to safe and culturally sensitive health care, free from racism and discrimination,” says the Honourable Patty Hajdu, minister of Indigenous Services Canada. “I commend the work and advocacy that lead to the creation of IDAC, and I look forward to following the progress ahead.” 27 Issue 1 | 2023 | Issues and People

Root perforations can and do occur for a variety of reasons and can lead to chronic infection, potentially resulting in tooth loss. Knowing how to recognize them and the best ways to treat them is the best strategy to anticipate and correct possible damage. How to Manage Root Perforations Mary Dabuleanu, DDS, MSc, FRCD(C), is a parttime clinical demonstrator at the University of Toronto for undergraduate dental students and graduate endodontic residents. Dr. Dabuleanu is a practising endodontist in North York, Ontario. Root perforations are stressful and occur regularly during or following endodontic treatment.1 Management of the perforations will largely depend on their nature and location. The increase in complex endodontic treatments makes it logical to envisage an increased frequency of perforations. While about half (53%) of iatrogenic perforations occur during post insertion, the remaining instances occur during routine endodontics treatment.2 Perforations can be pathological, resulting from caries or resorptive defects. But in the majority of cases, they occur during root canal treatment and can account for almost 10% of all cases of endodontic failure. Therefore, trying to avoid them altogether remains the best option. Dr. Mary Dabuleanu, clinical demonstrator at the University of Toronto for endodontic residents, advises taking time at the initial stages. “The access preparation requires a lot of focus and requires time,” she says. Often the result of attempts to locate andopen canals, perforations in the coronal and furcation third regions can be generated by pulp chamber and orifice calcifications, misidentification of canals, large crown-root angulation and excessive coronal dentine shrinkage. Perforations in the middle third can occur with overzealous instrumentation in this area, after an aggressive approach to crown descent with large instruments used in narrow canals. They can also occur if files are too large or if the filing technique is too aggressive in shaping the canals away from the root centre during root preparation. Traditionally, curved 29 Issue 1 | 2023 |