Volume 10 • 2023 • Issue 6

The Working Mind: Promoting Workplace Mental Health Page 8 2023 • Volume 10 • Issue 6 The Canadian Dental Association Magazine PM40064661

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. 2023 • Volume 10 • Issue 6 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 canadian-dentalassociation CanadianDental Association 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 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. CDABoardofDirectors President Dr. Heather Carr Dr. Raymon Grewal British Columbia Dr. Brian Baker Saskatchewan President-Elect Dr. Joel Antel Vice-President Dr. Bruce Ward Dr. Dana Coles Prince Edward Island Dr. Jerrold Diamond Alberta Dr. Mélissa Gagnon-Grenier NWT/Nunavut/Yukon Dr. Lesli Hapak Ontario Dr. Stuart MacDonald Nova Scotia Dr. Marc Mollot Manitoba Dr. Jason Noel Newfoundland/Labrador Dr. Kirk Preston New Brunswick 3 Issue 6 | 2023 |

© 2023 Garrison Dental Solutions, LLC Mention Code ADCACDA1223 150 DeWitt Lane Spring Lake, MI USA 49456 To order: Contact your authorized Garrison Dealer or call toll free 888.437.0032 or online at www.garrisondental.com Clinical Case Interproximal restorations using Garrison’s Wide Prep Ring Garrison exclusive! Fig. 1 Tooth 25 with cavitation mesial, occlusal view, initial situation 1 2 Fig. 2 Tooth 25 with cavitation, mesial buccal view, initial situation 3 Fig. 3 Prepared cavity with reduced palatal surface profile, subsequently polished distal tooth surface 24 5 Fig. 5 Placed Garrison premolar matrix and green ring, before etching and adhesive procedure 6 Fig. 6 Appearance of restoration with rough polishing 4 Fig. 4 Isolation of the quadrant with rubber dam 7 Fig. 7 Final polishing, occlusal view 8 Fig. 8 Final polishing, buccal view, restored contact surface and preserved mesial tooth profile 9 Fig. 9 Before/after occlusal Interproximal caries is the most common type of dental pathology and therefore interproximal fillings in the posterior area are the most common restorative procedures. Restoring adequate cervical contour and tight interproximal contacts are of utmost importance for long term stability of such restorations. Open contacts and cervical overhangs lead to development of secondary caries and periodontal pocket. Modern sectional matrices, interproximal wedges and ring systems like the Garrison sectional matrix system make the procedures more predictable and allow dental practitioners to restore such cavities easily. The presented case is removal of the interproximal caries with deep cervical margin and wide buccal and palatal extensions. After the cavity preparation and isolation with the rubber dam, Garrison matrix with extension, Blue (small) wedge and Wide Prep (green) ring were placed. The wide extensions of the ring allow to restore adequate buccal and palatal contours of the tooth. The sectional matrix is easily shaped to restore proper anatomy and tight contacts. The rest of the cavity is filled with respect of the simplified tooth anatomy. Rough polishing and contouring were done under the rubber dam isolation. After the removal of the rubber dam the procedure ends with fine polishing and occlusal corrections. Dr Filip Pezer SGR-KSH-10 contains: 1 Short Ring (blue) 1 Tall Ring (orange) 1 Wide Prep Ring (green) 50 Assorted Matrix Bands 50 Assorted Firm Matrix Bands 10 VariStrip™ 80 Assorted Wedges 12 Assorted Rally™ Polishers 1 Ring Placement Forceps (FXP01) Only Garrison helps you restore the largest preps.

Contents The Canadian Dental Association Magazine 2023 • Volume 10 • Issue 6 13 16 22 38 CDA atWork 7 Will the Government Get It Right? 8 CDA Partners with Mental Health Commission of Canada to Promote Workplace Mental Health 13 CDAnet Standard 2.4 to Retire in February 2024 News and Events 15 Dental Digest Issues and People 19 Searching for Materials for a Drill-Free Treatment of Caries 22 Exploring the Potential of AI and Dentistry Classifieds 34 Offices and Practices, Positions Available, Advertisers’ Index Supporting Your Practice 25 Know the Law: Fair Recruiting and Hiring Practices 28 The 5 R’s of Mental Health 30 Interest Rate Hikes Spark Interest in Annuities 32 A Little Respect Goes a Long Way Did You Know? 38 Test Your Mouthguard Knowledge 5 Issue 6 | 2023 |

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Dr. Heather Carr president@cda-adc.ca Will the GovernmentGet It Right? As I write this in early November, I’m thinking about the pending government announcement of details on the Canadian Dental Care Plan (CDCP). How will it affect my patients, myself and my colleagues across Canada? The federal government’s timeline indicates that CDCP dental benefits will be available to some Canadians at the beginning of 2024. With delays in an announcement, speculation and unofficial reports have arisen to fill the void. As CDA president and a practising dentist, I want to know whether this plan will help our most vulnerable patients. In early 2023, CDA published a policy paper for the federal government and the public that outlined what we—the dentists that provide dental care to Canadians every day—know would best serve the people who need it most. To improve the oral health of Canadians, a plan must provide patient-centred care, prioritize preventative care, not cause an undue administrative burden on dental offices, and be sustainable. I care for patients who could benefit from a well-designed plan, and I know what kind of oral health care they need. I know you do as well for the patients you see at your practice. Throughout the year, CDA and the provincial and territorial dental associations (PTDAs) have provided the federal government with critical data, information and insights about how dental care works at the practice level to meet patient needs. We have stressed that the CDCP must avoid unintended consequences, such as employers dropping their existing dental benefit plans. Such a loss could increase the number of patients eligible for CDCP from an estimated 9 million to 17 million. The associated costs would impact the sustainability of any federal oral health plan. We’ve done everything possible in providing the federal government with information and advice. I sincerely hope that they carefully consider these submissions and have listened to what we’ve been saying as they developed their plan (p. 15). Our goal has always been to ensure that you can focus on what you do best—caring for Canadians. In October, the PTDA presidents sent an open letter to MPs expressing their concern that dentists, patients and taxpayers still had no details about the government’s plans. The letter reiterated that it’s dentists, “who will be expected to deliver on the government’s promises” of increased access to care in an environment where there are still significant obstacles for many patients as well as staffing challenges in dental offices. CDA and the PTDAs synergistic efforts have a common goal, yet we serve our profession in two important, but parallel, ways. As the national voice of dentistry, CDA must maintain a relationship with the federal government to provide information on the needs of dentists and advocate for the oral health of vulnerable Canadians. No matter the makeup of parliament, CDA will always provide frank counsel, while reminding the federal government that oral health care is largely delivered through private dental offices at the provincial and territorial level. We’ve also strongly encouraged Health Canada to engage in meaningful consultations with the PTDAs. The PTDAs are taking the lead in preparing you, their members, for what is to come and advocating strongly and publicly for what dentists need from this plan. When details on the CDCP are announced, the PTDAs will be your best support in determining how it affects your community. Our collective efforts will persist once details of the plan are released. CDA and the PTDAs will continue to work with governments for changes that will improve access to care and ensure the best possible oral health outcomes for Canadians. From the President 7 Issue 6 | 2023 | CDA atWork

Workplace Mental Health &Wellness for Oral Healthcare Professionals Course Objectives The Canadian Dental Association partnered with the Mental Health Commission of Canada to adapt The Working Mind (TWM) program for oral health professionals. TWM for Oral Healthcare Professionals is an evidence-based training course developed to initiate a shift in the way you think, act, and feel about mental health in the workplace. It is specifically designed for dental professionals and office staff in the oral healthcare sector. The course offers an employee (staff) version and a manager (dentist) version for supervisors and team leads. This course is offered virtually or in-person. Course Overview Three CoreModules offer the same foundational content to both employee and manager participants. They focus on increasing self-awareness and taking care of your own mental health. Module 4 is presented in the manager (dentist) course. 9 Module 1: Mental Health and Stigma will introduce participants to the concepts of mental health and stigma, and it will discuss impacts of stigma on individuals living with mental health problems. 9 Module 2: Mental Health in the Workplace will help recognize and keep track of changes in your mental health andwell-being and know when to take appropriate actions and have conversations about mental health with colleagues and friends. 9 Module 3: Stress & Resilience will discuss the impacts of stress on mental health and provide an opportunity for participants to practise the Big 4 coping strategies — proven tools to help deal with stress effectively and remain resilient. 9 Module 4: Supporting Your Team will build on the three coremodules and introduce managers (dentists) with practical tools to support individual employees, and to support their team’s mental health. Please note: the course provides a safe space for sharing; however, it is not mandatory to share personal experiences. Sponsoring organizations may offer this course in-person. The in-person course curriculum is the same as the virtual option. The four modules are designed to be delivered: 9 In the order given, as the content builds on each previous module. 9 Spaced apart, within a timespan of no longer than 2 weeks. 9 Organized into separate employee and managers cohorts. Course Group Size and Requirements: In-person group sizes can range from 8 to 25 participants. Virtual group sizes can range from a minimum of 8 participants to a maximum of 15 participants. The course can be delivered via Zoom or Microsoft (MS) Teams. Learn more: 1.866.989.3764 • theworkingmind@mentalhealthcommission.ca • www.theworkingmind.ca Suite 1210, 350 Albert Street, Ottawa, ON K1R 1A4 • Fax: 613.798.2989 • bd@mentalhealthcommission.ca • www.mentalhealthcommission.ca The Working Mind for Oral Healthcare Professionals — Created for the Canadian Dental Association CDA Partners with Mental Health Commission of Canada to Promote Workplace Mental Health Like many health care professionals, dentists face numerous challenges in the workplace. The teaching and health care professions continue to have some of the highest rates of burnout, and the COVID-19 pandemic has only increased these levels. The consequences of mental health challenges are significant and can have a dramatic impact on patients and staff, as well as potential financial losses. Conscious of these issues, CDA and the Mental Health Commission of Canada (MHCC) teamed up to create a customized course for dentists and their teams called The Working Mind: Workplace Mental Health & Wellness for Oral Health Care Professionals available for use by dentists in Canada. 8 | 2023 | Issue 6

The Working Mind for Oral Healthcare Professionals — Created for the Canadian Dental Association 3 OVERVIEW ON TRAINING FORMATS: This course is available both virtually and in-person. Whichever format you choose to sponsor, individuals will have the same opportunity to learn more about mental health in the workplace and how to take care of their own. For the virtual format: • The course can be delivered via Zoom or Microsoft (MS) Teams. Zoom is highly recommended as it offers superior functionality. • Participants must have access to a working camera, microphone and speakers or earphones for each session. • If participants choose to use Zoom, they’re required to make a free Zoom account. For the in-person format: • A venue with adequate space must be provided. • Meals should be arranged ahead of time, either by catering or bringing your own food. • If the facilitator isn’t local, then a travel estimate will be provided to clients. FREQUENTLY ASKED QUESTIONS: 1. What are the group sizes? This depends on if the course is virtual or in-person. Virtual group sizes range from 8 to 15 participants, and in-person group sizes range from 8 to 25 participants. 2. How long does it take to complete the course? Here’s a breakdown of the time commitment for both managers and employees: Manager virtual: 7 hours total (can be delivered over one day or split into two days, within a two-week period) Manager in-person: 8 hours total (can be delivered over one day or split into two days, within a two-week period) Employee virtual: 5 hours total (can be delivered over one day only) Employee in-person: 4.5 hours total (can be delivered over one day only) 3. Do I need to bring any training materials or supplies? The participant materials are sent prior to the course to be distributed. We recommend you bring any of your organization’s mental health resources as well. 4. How can I sign up for this course? You can complete the Intake Form (at the end of this document) and return it to bd@mentalhealthcommission.ca. A coordinator will be in touch to finalize the contracting and scheduling process soon. Learn more: 1.866.989.3764 • theworkingmind@mentalhealthcommission.ca • www.theworkingmind.ca Suite 1210, 350 Albert Street, Ottawa, ON K1R 1A4 • Fax: 613.798.2989 • bd@mentalhealthcommission.ca • www.mentalhealthcommission.ca Welcome to The Working Mind: A Guide for Sponsoring Organizations At the height of the pandemic, CDA’s COVID-19 Practice Recovery Task Force culminated its work into a new customized coursecalled, TheWorkingMind:Workplace Mental Health & Wellness for Oral Health Care Professionals. We’re proud to share our findings and help our community take the best care of themselves and others. Your place of work can play an essential part in helping to boost or maintain positive mental health. They can be places where people feel productive, and a good workplace can be a strong contributor to an employee’s overall well-being. Conversely, a stressful work environment can increase the risk of mental health issues and disorders, which account for approximately 30% of all short- and long-term disability claims in Canada. They can also lead to staff absenteeism and turnover, which costs Canadian businesses billions per year, and dental offices have not been spared. widely available, we hope to empower the complete dental team to prioritize their well-being, foster a supportive atmosphere, and to ultimately enhance the care they provide to patients.” “Conversations about your own and your colleagues’ mental health are not easy,” adds Geoff Valentine, head of programs and services at CDA. “This customized course provides all team members with strategies to help make those conversation happen, when they are needed.” Designed to be flexible to meet a range of needs, the course can be taken in-person or online. It consists of three modules for all members of the dental team plus an additional module specific for dentists (as leaders of the practice), to help lead their teams toward a healthier work environment. “Flexibility is so important in today’s workplace, and we hope that by having the courses available with a range of options will make is easier for people to fit this important topic into their busy lives,” says Valentine. “Teaming up with CDA, the MHCC reinforces our dedication to the mental health and well-being of oral health care professionals nationwide,” says Shane Silver, MHCC vicepresident, Opening Minds. “This evidence-based, customized training program helps reduce mental health-related stigma and creates an environment where people come first and are comfortable engaging in discussions and seeking help. The result is a healthier workplace, which leads to an overall healthier Canadian workforce.” “When CDA and the provincial and territorial dental associations prioritized the issues facing dentists and dental practices, mental health was top priority for everyone participating,” says Dr. Aaron Burry, CDA CEO. In October 2023, CDA and the MHCC officially launched a new collaborative project to mark Healthy Workplace Month. The Working Mind: Workplace Mental Health & Wellness for Oral Health Care Professionals course is designed to help Canadian dentists prioritize their own mental health and well-being while also maintaining a work environment that is conducive to delivering optimal patient care. CDA and MHCC are committed to creating an inclusive atmosphere where individuals can address mental health concerns without any fear of judgment by removing stigma and raising knowledge about mental health. The program was created specifically for dentists and their practice and office staff members. “The course provides a safe space for oral health professionals to explore the importance of maintaining positive mental health in their workplace,” says Dr. Heather Carr, CDA president. “By making this course The course provides a safe space for oral health professionals toexplore the importance of maintaining positive mental health in their workplace. 9 Issue 6 | 2023 |

For more information on The Working Mind course, visit: oasisdiscussions.ca/the-working-mind In a brief testimonial video posted on CDAOasis (oasisdiscussions.ca/the-working-mind), dentists who have participated in the Working Mind course share their thoughts and experiences, including Dr. Daniel Violette of Edmundston, New Brunswick. Provincial and territorial dental associations who are corporate members of CDA, along with other organizations and societies, can now sponsor dentists and their teams to organize and take the Working Mind program. The three full-team modules cover the topics of mental health awareness, reducing stigma, encouraging mental health conversations, strengthening resilience, and help to self-support. The fourth module, specific to dentists or managers, offers practical tips regarding how to support your team’s mental health and well-being, ensuring that the workplace environment is respectful and inclusive, and encouraging people to seek help for mental health issues, if required. “Empowering both colleagues and managers in an oral health care setting, the course can help individuals learn how to recognize the subtle signs of mental health challenges,” says Valentine. “Our goal is to help create workplaces where all employees not only feel supported in their well-being, but also encouraged to seek help for any mental health issues they may encounter.” About the Mental Health Commission of Canada: The Mental Health Commission of Canada (MHCC) is a registered charity created to focus national attention on mental health issues. Our work is to improve the mental health outcomes for all people living in Canada. Opening Minds is the social enterprise division of MHCC that provides training programs to promote mental health, wellness and resilience, and eliminate stigma around the world. 10 | 2023 | Issue 6

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THE ORIGINAL WATER FLOSSER. ✓ 60+ years of innovation ✓ Backed by 80 published scientific studies1 ✓ 25 water flosser models and 7 unique tip options Waterpik® is the #1 water flosser brand for a reason. *When used as directed. 1. Data on file. Water Pik, Inc. Disclaimer: It is not recommended to use a mouth rinse in any Waterpik® water flosser. Discover the benefits of being an Insider. Sign up for the Waterpik® Insider Program at waterpik.ca/sign-up THE DENTIST FORMULATED ALCOHOL…FREE ORAL RINSE. pH neutral Free of alcohol, dyes, and sulphates Non-burning Fights bad breath for 12 hours* Experience the TheraBreathTM diˆerence. Waterpik® is the only water flosser to earn the CDA Seal. The following Waterpik® benefits are validated by the CDA: • Removes up to 99.9% of plaque from treated areas. • Up to 50% more effective for improving gum health vs. string floss. • Up to 2X more effective for improving gum health around implants vs. string floss. • Up to 3X more effective for removing plaque around braces vs. string floss. The CDA has also validated the following claim for TheraBreathTM Mild Mint: freshens breath.

CDAnet Standard 2.4 to Retire in February 2024 REMINDER! Most claims processors use CDAnet standard version 4.2 to process dental benefit claims, but a limited numberof claimsprocessorsarecurrentlyupgrading their systems to meet the upcoming February 1, 2024, retirement deadline for version 2.4. Practice management software in dental offices will need to have the settings for some insurance companies updated to ensure claims are no longer sent in version 2.4. CDA will send out communications explaining when to make changes, as some claims processors may be ready before the deadline. After February 1, all claims processors settings should be set to version 4.2. Retiring version 2.4 will have benefits for dentists, claimsprocessorsandsoftwarevendors, including: Save time and money With version 4.2, more types of claim transactions are available for dental offices and claims processors to improve patient claim services. Dental software vendors and claims processors will no longer need to develop their systems to support both versions. Increase coordination of benefits claims Retiring version 2.4 will simplify the coordination of benefits (COB) process. Many claims processor systems cannot accept version 2.4 explanation of benefits (EOB) in a COB claim, but this limitation will be 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 now have the ability to add accepting attachments to messages for their members. This will increase efficiencies for both the dental office and the claims processor. Data accuracy After February 1, all claims processors will be accepting version 4.2. And remember that your practice management software will need to have the claims processor settings updated to ensure claims are no longer sent in version 2.4. Streamlined support Dental software vendors, networks and claims processors will only need to support version 4.2 systems and processes. CDA is prepared and ready toworkwith theCDAnet community to ensure a smooth transition to the new CDAnet version 4.2. Version 2.4 of the Message Formats and Standards for Electronic Dental Claims for CDAnet, also known as the CDAnet Standards, will be retired effective February 1, 2024. LOOK FOR MORE DETAILS IN 2024! 13 Issue 6 | 2023 |

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Dr. Carlos Quiñonez, vice dean and director of dentistry at the Schulich School of Medicine & Dentistry, was elected to fellowship in the Canadian Academy of Health Sciences (CAHS), one of the highest scholarly honours in Canada. “It is truly an honour to be recognized like this. I am humbled. Most importantly, this recognition speaks to the hard work of my collaborators and students, as nothing is possible without them,” said Dr. Qui onez. “And of course, I’d be nowhere without the sacrifices of my family, who have allowed me the luxury of being committed to my work.” Dr. Quiñonez’s research examines the history, politics and economics of dentistry with a focus on health and social equity. He is a global leader on the political economy of dentistry and his research is often cited by both public and private agencies alike. Dr. Carlos Quiñonez Receives Fellowship in Canadian Academy of Health Sciences Dr. Carlos Quiñonez CAHS fellowship is awarded to those who have demonstrated leadership, creativity, distinctive competencies and a commitment to advance academic health science on a national and global level. See: bit.ly/3QiXEvi DENTAL DIGEST On October 26, the presidents of the provincial and territorial dental associations (PTDAs) sent a let ter to Members of Parliament (MPs) about the lack of information being shared about the pending Canadian Dental Care Plan (CDCP). The PTDA presidents were concerned that the CDCP had been compromised by a lack of meaningful consultation with dentists, who will be expected to deliver on the government ’s promises. In the media release announcing the let ter to MPs, Dr. Derek Thiessen, president of the College of Dental Surgeons of Saskatchewan, was among the PTDA presidents quoted: “This new program has the potential to improve access to care for many Canadians. It must be sustainable, patient-centred, and easy to access for patients. A poorly designed program will not improve access to care which is something we would like to avoid. We want this to work for Canadians.” PTDA PresidentsWrite to MPs on Federal Dental Insurance Plan To read the full letter to MPs, see: bit.ly/462IQHe 15 Issue 6 | 2023 |

Antimicrobial resistance (AMR) is one of the top global health threats, yet many people don’t fully recognize the harm it is causing. A new Canada-wide colour campaign (#GoBlueForAMR) was launched during World AMR Awareness Week (November 18–24) to increase the visibility of AMR and share knowledge on how to tackle this growing threat. “As dental professionals, we have a crucial role to play in reducing antimicrobial resistance and stopping the emergence of drug-resistant infections,” says Dr. Heather Carr, CDA president. “World AMR Awareness Week is a reminder that together, we can help safeguard public health today and for future generations.” Dentists frequently remind patients about the potential risks of overuse and the importance of completing full, prescribed courses of antibiotics. “Not all bugs need drugs. By working together, we can develop effective strategies to prevent and control antimicrobial resistance,” says Dr. Aaron Burry, CDA CEO. “AMR is a risk to all of us and we all have a role to play in preventing it.” For more details on the Go Blue for AMR campaign see: AntimicrobialAwareness.ca Dentists Can Help in the Fight Against Antimicrobial Resistance MINIMIZE SP I E NR UF SORATION. MAXIMIZE CLINICAL EFFICIENCY. www.hiossenimplantcanada.ca DIGITAL SINUS SOLUTION Industry’s most trusted guided indirect sinus lift system. Learn more C M Y CM MY CY MY K Hiossen-DigitalSinusSolution-PrintAd-1335-English.pdf 1 9/12/23 6:45 AM

Join us ‘in-person’ Vancouver, BC Three days of varied and contemporary continuing dental education sessions are offered (something for your whole team) Fantastic line-up of speakers / topics to choose from in open sessions and hands-on courses, as well as the Live Dentistry Stage in the Exhibit Hall Spacious PDC Exhibit Hall with all your favorite exhibiting companies looking forward to connect with you again Lunches & Exhibit Hall Receptions (Thurs/Fri) included in the registration fee Fantastic shopping, beautiful seawall access within blocks of your hotel, and great spring skiing, golfing and cycling pdconf.com Registration and Program information at... Pacific Dental Conference March7-9, 2024 Save these Dates! in conjunction with the Canadian Dental Association Pacific Dental Conference Featured Speakers Jeff Brucia Materials/Restoration Carolyn Stern Communications Theresa Gonzales Forensics/ Pathology Peter Nkansah Dental Emergencies Ernest Lam Radiology Tija Hunter Dental Assisting Fernanda Almeida Alan M. Atlas Dani Botbyl William ‘Bo’ Bruce Mahmoud Ektefaie Shannon Pace Brinker Rodrigo Sanches Cunha Karen Davis Amy Doneen Faraj Edher Chrissy Ford Jeffrey Hoos Nekky Jamal Carlos Quiñonez Mark Lin Brian Nový Giovanni Olivi Michael Wiseman Miles Cone Jeff Coil Bethany Valachi

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As a pediatric dentistry, Dr. Hetal Desai often treats children who are afraid of needles. “The question arises from parents, can’t we come up with treatments for childhood caries that doesn’t require needles?” she says. “To place fillings, we need to drill the tooth structure, and, to drill, we need to use a needle to administer anesthesia.” Searching for Materials for a Drill-Free Treatment of Caries Dr. Hetal Desai is a pediatric dentistry resident at the University of Toronto (Uof T). Dr. Desai has begun a research project to develop a minimally invasive treatment for caries. “This is largely a question of materials, not technique,” she says. The materials currently used most frequently require that decay be drilled and then materials replace the missing tooth structure. But a material that penetrates decayed tooth structure and bonds to it wouldn’t require drilling. “Low viscosity resin has been effective in treating white spot lesions or chalky white lesions that form after orthodontic treatment,” says Dr. Desai. “White spot lesions are incipient lesions that demonstrate increased porosities in the enamel structure due to demineralization. The porosities allow the resins to penetrate the tooth 19 Issue 6 | 2023 |

Watch the full conversation with Dr. Desai on CDA Oasis: bit.ly/3MtQLGn structure, removing the need to drill. These low-viscosity resins bond on the tooth structure after penetration and form a barrier that prevents further loss of minerals (demineralization), leading to caries arrest.” When the scope of application for low viscosity resin was widened to include larger lesions, efficacy of caries arrest began to fall. “There are inherent shortcomings with these resin materials. They create a barrier, however, in larger lesions these barriers do not effectively isolate the carious lesions from the oral environment. Therefore, some bacteria that remain trapped within the lesion may continue to thrive, resulting in caries progression,” she says. “As well, these resins tend to degrade over time because of the enzymes from the bacteria and in saliva.” In the lab, Dr. Desai and her team, which includes Dr. Cameron Stewart and faculty member Dr. Yoav Finer, are working on modifying previously designed silicon mesoporous nanoparticles, which have pores where an antimicrobial drug can be stabilized, to optimize drug release. “As the nanoparticle absorbs water from the oral environment, the pores will swell and release the drug, slowly over time, in a controlled manner,” she says. “Because the nanoparticle is porous, we can incorporate a lot of the drug into it, and, theoretically, it could be released slowly over 30 years.” Of course, the low viscosity antimicrobial resin is still a work in progress. “We’ve found that we can make a resin with 10% nanoparticles without substantially altering its physical properties,” she says. “And we’ve found that over 90 days in the mouth, about 10% of the antimicrobial drugs were released, which is promising. Now we need to test its effectiveness in inhibiting bacterial growth to see what this formulation will do to biofilm,” says Dr. Desai. If the newmaterial is proven to be effective in preventing bacterial growth in larger lesions, she believes it might be something that can be added to resin materials and used to treat caries without drilling. “A drill-free treatment could foster a more positive relationship with dental care for children that would last a lifetime,” Dr. Desai says. Dr. Desai also notes that the high efficacy of low viscosity resin for white spots may also be related to the spots usually being located on front teeth. “Front teeth tend to be brushed well, whereas in the back of the mouth, brushing is more of a problem,” she says. How can these problems with low viscosity resin be solved so that applying it directly to a carious lesion is an effective treatment? “The properties of the material need to be modified so that it doesn’t facilitate bacterial growth,” says Dr. Desai. “So, if the material itself had antimicrobial properties, that would be fantastic. And we need to figure out how to prevent it from breaking down so we can increase the lifespan of restorations.” Dr. Desai and her research team at U of T began to utilize newly developed low-viscosity, biostable resins that are less susceptible to degradation and to add technology with antimicrobial effects. “We’re using nanoparticles to deliver antimicrobial drugs to the tooth structure,” she says. “Just adding an antimicrobial agent directly to the resin appears to interfere with viscosity and the antimicrobial agent is often only released from the resin for a limited amount of time, only for a few days.” Just adding an antimicrobial agent directly to the resin appears to interfere with viscosity and the antimicrobial agent is often only released from the resin for a limited amount of time, only for a few days. As the nanoparticle absorbs water from the oral environment, the pores will swell and release the drug, slowly over time, in a controlled manner. 20 | 2023 | Issue 6 Issues and People

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Exploring the Potential of AI and Dentistry Dr.Thomas Nguyen is an assistant professor at the McGill Faculty of DentalMedicine andOral Sciences. In 1943, the first scientific paper to discuss what would eventually become the field of artificial intelligence (AI) was titled, A Logical Calculus of the Ideas Immanent in Nervous Activity. It drew upon the ideas of Alan Turing, who is considered the father of theoretical computer science. “Although it has been a discipline for more than 70 years, for most of that time AI remained mainly theoretical because of a lack of computing power,” says Dr. Thomas Nguyen, an assistant professor at McGill University and co-author of a 2021 JCDA article1 on AI anddentistry.“In2012, therewas anexplosionof AI in termsof research and publication.”That year, deep learning began to dominate the field of AI, and it saw some success due to computer hardware improvements and access to large amounts of data. “In recent years, applications of AI have become mainstream, as I’m sure most of us have seen” says Dr. Nguyen. A neural network called DALL·E that creates images from text captions was released in 2021. ChatGPT, an AI-powered language model that generates human-like text, launched in 2022. “We can expect AI to influence dentistry in the near future,” says Dr. Nguyen. 22 | 2023 | Issue 6

Machine learning uses algorithms trained on data to produce adaptable models that can perform a variety of complex tasks. Most studies suggest that that if you compare a specialist in oral pathology or oral radiology to an AI system, they achieve almost the same levels of accuracy and precision. Both are between 92% to 98% accurate. Different Kinds of AI AI encompasses a group of technologies and can be defined as when “a machine or a computer can perform a task that would usually require human intelligence,” says Dr. Nguyen. “AI can learn, create new knowledge, and solve problems through machine learning.” Machine learning uses algorithms trained on data to produce adaptable models that can perform a variety of complex tasks. One application of machine learning that is common is facial recognition programs. Machine learning algorithms analyze and process facial features from images or videos, which allows the system to learn patterns and characteristics unique to each individual face. Dr. Nguyen says there are some misconceptions about the type of tasks that AI can do. “For example, ChatGPT is a language tool, that’s what it does. If you ask it to predict when Bitcoin is going to reach a million dollars, it can’t do that. It just focuses on language,” he says. AI in Dentistry “At this time, computer vision is the strongest application of AI in dentistry,” says Dr. Nguyen. Computer vision trains computers to interpret and understand the visual world. Using digital images and deep learning models, computers can accurately identify and classify certain objects. “We could use it in oral pathology or in radiology to diagnose and identify different structures in an X-ray,” Dr. Nguyen says. “Most studies suggest that that if you compare a specialist in oral pathology or oral radiology to an AI system, they achieve almost the same levels of accuracy and precision. Both are between 92% to 98% accurate. But it takes about 28–30 minutes for an expert to give a proper diagnosis, and it takes AI about 30–32 seconds.” In dentistry, the diagnosis of caries can be controversial and somewhat subjective. “We don’t always agree, one dentist with another,” says Dr. Nguyen. “An AI system could help identify zones, but it would still ultimately be the clinician who decides what to do. Monitor it? Treat it? AI could be a tool to help in the final clinical decision.” Dr. Nguyen says there is potential for AI to Deep learning is a subset of machine learning, which differentiates itself by using more data. If machine learning uses thousands of data points, deep learning uses millions. “Deep learning mimics the way the human brain learns,” says Dr. Nguyen. “It works through a network of neurons and one can give it a bunch of information that is not labeled, that is all mismatched, and a deep learning neural network will classify it on their own and find its own logic to learn new information or skills.” In neural networks, there are hidden layers between the input and output of the algorithm; these hidden layers are where the algorithm does its work and information is analyzed, processed, and transformed into an output. “Some neural networks can be many hidden layers deep,” says Dr. Nguyen. Hidden layers are what make the complexity of AI possible, and they create intricate algorithms that are not easily understandable by humans. Hidden layers make it difficult to understand how AI systems process data and generate predictions or decisions. “We only see the outputs,” says Dr. Nguyen. “But the inputs are huge. For example, for ChatGPT, the inputs encompass most of the entire Internet up until 2021. And the outputs are the conversation you can have with the application.” 23 Issue 6 | 2023 | Issues and People

In health care, we have to be careful about confidentiality issues when working with patient data. To have enough data to create a useful tool, we need to collect it together from many sources. How do we keep it safe? be used in endodontics to help identify second mesiobuccal (MB2) canals. “More patients are getting implants, and when they have issues with them many years later, often they don’t have the information we need about the implants,” he says. “Currently, we sometimes have to access the implants and we don’t have the proper tools or know which kind of implant we are dealing with. Dentists have to look at a database of implants and go through them one by one.” Dr. Nguyen’s research suggests that an AI system that could quickly identify implant types would save time and effort in dental practices. to create a useful tool, we need to collect it together from many sources. How do we keep it safe? However, this is more a concern for researchers rather than everyday users.” For people who use AI, accountability is also a concern. “What happens when an AI system makes a mistake?” says Dr. Nguyen. “Is that the fault of the AI? The company that made the AI? Or the user? We are going to need appropriate regulation to address these questions.” He also cites ethical issues as a potential problem for some AI technologies, though not just specific to dentistry. “A Black researcher in Boston found that the face recognition AI she was working with couldn’t recognize her because the data set it was trained on had an uneven distribution of races,” he says. AI isn’t a panacea, according to Dr. Nguyen. “If you have bad quality information going in, you’ll have bad quality results come out,” he says. At the end of the day, Dr. Nguyen doesn’t believe that people should be fearful of AI. “AI can’t replace dentists,” he says. “It’s a powerful tool that will help us be more effective and will give us more time to communicate with our patients. Ultimately, AI will be a win-win for dentists and patients.” Concerns about AI “AI is very hungry for data,” says Dr. Nguyen. “In health care, we have to be careful about confidentiality issues when working with patient data. To have enough data Watch a full conversation with Dr. Nguyen on AI and dentistry on CDA Oasis: bit.ly/3QDSjA1 Reference: 1. Nguyen TT, Larrivée N, Lee A, Bilaniuk O, Durand R. Use of Artificial Intelligence in Dentistry: Current Clinical Trends and Research Advances. J Can Dent Assoc 2021 May;87:l7. 24 | 2023 | Issue 6 Issues and People

KNOWTHE LAW Fair Recruiting and Hiring Practices Inna Koldorf is a partner in the Employment and Labour Law Group at KPMG Law LLP in Toronto. Her work includes helping employers with managing their workforce, providing advice, representing employers in litigation, and conducting workplace investigations. The views expressed are those of the author and do not necessarily represent the opinions and official policies of CDA In Canada, everyone has the right to equal treatment for consideration for employment without discrimination. Employers are expected to create workplaces and HR processes where human rights are respected and employees are given equal opportunities. “During recruitment and hiring, it is important to consider how to proceed in a way that is fair and non-discriminatory,” says Inna Koldorf. “If the process isn’t fair, then candidates who aren’t hired could make human rights claims against your business.” Koldorf says that many provinces and territories provide accessible and easy to understand information online about how employers should proceed while recruiting or hiring. In Ontario, for example, such resources are published by the Ontario Human Rights Commission. “I always recommend reviewing these resources,” she says. “It helps to have it top-of-mind when going through all the steps of the hiring process.” 25 Issue 6 | 2023 |

A recruitment process that uses tangible and concrete factors for decision making is less likely to be influencedby an employer’s own ideas or biases about candidates’ backgrounds, personal characteristics or personal lives. Once you have a pool of potential candidates short listed, resist the temptation to search for them online. “There was a time when a lot of businesses would visit social media sites to look up candidates or Google their names to find a little more personal or professional information about them,” Koldorf says. “It’s natural to be curious, but it doesn’t respect the privacy of the candidates.” Searching potential candidates online might turn up information, such as a candidate’s race, family status, marital status, or disability, that is protected under human rights legislation. “You don’t want this information to creep into your subconscious and influence your decisions,” Koldorf says. “For example, if the position requires long hours and you see that a candidate has young children, you might assume that they can’t or won’t be willing to do so. But that may not be true.” These scenarios also might open you up to liability. In some jurisdictions in Canada, there is privacy legislation that prohibits this practise outright. Make decisions about who to interview for the position based on the applications from the candidates. “My suggestion is to try to compare apples to apples,” says Koldorf. “Compare each applicant’s education and experience against the job description.” A recruitment process that uses tangible and concrete factors for decision making is less likely to be influenced by an employer’s own ideas or biases about candidates’ backgrounds, personal characteristics or personal lives. Interviewing Keep your interview questions related to the job description and the relevant skill requirements. “Questions that may be suitable in social situations, such as those about age or children or country of origin, are not appropriate in this professional setting,” says Koldorf. It’s also helpful to work from a list of questions that get asked to each candidate. “Again, this helps you to compare apples to apples,” she says. If there is a question that might only come up for a candidate of a certain race, gender or age group, that’s a red flag that it might not be an appropriate interview question. Accommodations should be made for candidates who may need them to participate in the interview process. If a candidate’s disability comes up during the interview process, and it could be accommodated to allow the person to perform the role, then they should continue to be considered for the job. To not make appropriate accommodations for this candidate could be a violation of human rights legislation. If you need to conduct a criminal record check, you need written consent from the candidate. “If a candidate will be working with children or dealing with large sums of money, you’d likely want to get one done,” says Koldorf. “You will also want to get a vulnerable sector check, which includes additional information not included in a criminal record check.” Every jurisdiction in Canada is a little different. “In Ontario, the Human Rights Code protects Recruiting When you begin the recruitment process and create a job listing, include specific skills and characteristics that are directly related to the tasks that will need to be performed. “Stick to what’s relevant as far as education, training and work experience,” says Koldorf. 26 | 2023 | Issue 6 SupportingYour Practice