Fall 2006eanews

Bloomfield Hills - Troy50 W. Big Beaver, Ste. 200Bloomfield Hills, MI 48304248 647-7930

Waterford - Pontiac2335 Pontiac Lake Rd., Ste. DWaterford, MI 48328248 683-2300

Clinton Twp. - Sterling Heights15870 19 Mile Rd., Ste. 110Clinton Twp., MI 48038586 286-3390

Rochester - Lake Orion1460 Walton Blvd., Ste. 208Rochester, MI 48309248 656-1626

Farmington Hills - W. Bloomfield31410 Northwestern Hwy., Ste. CFarmington Hills, MI 48334248 737-1360

St. Clair Shores - Roseville18303 E. Ten Mile Rd., Ste. 150Roseville, MI 48066586 773-2000

Ann Arbor - Ypsilanti315 E. Eisenhower Pkwy., Ste. 220Ann Arbor, MI 48108734 761-3166

Clarkston - North Oakland6770 Dixie Highway, Ste. 300Clarkston, MI 48346248 620-0002

Sterling Heights - Troy43114 DequindreSterling Heights, MI 48314586 254-1110

Inside

eanewsan extension of your practice

Carl BotvinickRichard SomerlottMichael GlassAllan JacobsRichard RubinsteinRichard GardnerGerald Dietz, Jr.

Mark DylewskiAlayne EvansEdward FitzpatrickMichael HoenStephen NavarreVlad TismenetskiyMark RobinsonThomas Vokal

2 Fall Classics 3 Pain Relief in Irreversible Pulpitis 4 Fighting for a Cure

E ndodontic Associates is poisedto open two new officesexpanding their practice fromthe seven current locations to

nine offices by the 4th quarter, 2006.From a single office in Bloomfield Hillsfrom 1960 – 1980, Endodontic Associateshas grown and expanded in response totheir referring doctor and patient’sneeds. In succession, six locations wereadded to the EA family, ClintonTownship, Waterford, Rochester, AnnArbor, Farmington Hills and St. ClairShores, so that Endodontic Associatescould continue to be available to theirever expanding patient base andremain convenient to where theirpatients live, work and travel.

The Clarkston Office located on DixieHighway and M-15 in the Mid-OaklandMedical Center will be primarily staffedby Doctors Carl Botvinick and AllanJacobs. The Sterling Heights Officelocated at Square Lake and Dequindrewill be primarily staffed by DoctorsJerry Dietz, Jr. and Vlad Tismenetskiy.Other Endodontic Associates doctorsmay cover the two new offices on a parttime rotational basis until additionalendodontists can be added.

Two New Office Locations Available Soon

The new offices are geographicallypositioned in areas where EndodonticAssociates has existing relationshipswith the local dentists and alreadyreceives many patient referrals. Bothoffices will be outfitted with state of theart operatories including digital radiographyand high powered microscopes. All 9EA offices are linked to one centralserver so that patient charts, records,radiographs, and case history can beshared and accessed at any office.

Endodontic Associates will continueto strive to be your premier group madeup of 9 contiguous and integrated indi-vidual offices that practice together. Weoffer quality expert care while offeringyour patients the ability to be seenquickly at convenient locations. Forinformation about the two new loca-tions, please contact Dr. Jerry Dietz,Sr. or Denise Cartier at Endo Central,248-647-7930. n

EmeritusGerald Dietz, Sr.Melvyn EderJohn Dylewski

We offer quality expert care while offering your patients the ability to be seen quickly

at convenient locations.

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Fall 2006 www.endodonticassoc.com

Endodontic Associates - Bloomfield,Rochester and Farmington Hills officeshosted their annual staff parties theweek of September 25. Our EA doctorsfeel that when our staff get to know thereferring doctor’s staff on a personallevel, a warmer and more attentive relationship develops that translates intobetter service for the patients. EA ishappy to treat staff to an evening outand have found that they really appreci-ate the informal opportunity to mingle.

Many guests said - “they appreciatethe personal interaction with EA staff asit helps them make a more meaningfulendodontic referral for their patients. It’sgreat to personally meet and spend timewith those at the other end of the phone.It helps our patients feel more comfort-able going to the endodontic office.”

The Bloomfield event was attended byover 175 people, at Bahama Breeze inTroy, on Tuesday, September 26. Locatedon the outdoor deck, the atmosphere pro-vided a relaxing evening away from thepressures of the office. Festive frozendrinks and Caribbean cuisine turned acool Michigan evening into a hot night.The prize raffle sent many of the guestsaway with a parting gift and the grandprize winner, Angie Bayless from Dr.Hopcian’s office won a pair of tickets tothe Tigers vs. Yankees Game 3 AmericanLeague Divisional Series on Friday,

Fall Classics with Endodontic Associates

Endodontic Associates participated inthe Michigan Multiple Sclerosis MS150 bicycle ride on July 15 and 16.The challenging 156-mile road courseran from Springfield Oaks in Davisburgto Lansing and back covering 78 mileseach way over the two days. Over 750riders participated in the gruelingMichigan event with steamy tempera-tures of 100 degrees on the summer’shottest weekend. Dr. RichardRubinstein representing the doctorsof Endodontic Associates finished thetwo-day event in 11.5 riding hours.Endodontic Associates contributedover $5,000 towards his ride. All ofthe money raised funds research andpatient assistance for people with MS.The Michigan race is one of severalhundred national road and mountainbiking races hosted by the NationalMultiple Sclerosis Society every yearraising over $60 million dollars forthe fight against MS. For more infor-mation about the National MSSociety’s Bike Tours, please visitwww.nationalmssociety.org. n

October 6 which the Tigers won 6 - 0.The Farmington Hills staff entertained

over 100 people at Lucky’s in the NoviFountain Walk for an evening of food,drinks and games on Thursday,September 28. Referring staff had achance to visit with EA staff in a relaxedcomfortable atmosphere. The luckygrand prize winner of the night wasValerie Schoen from Dr. Pulgini’soffice, who won two tickets to the Tigersvs. Yankees ALDS Playoff Game atComerica Park.

Rounding off the triple play of staffparties was the Rochester office staffparty at the Rochester Beer Company onThursday, September 28. The RochesterStaff hosted over 150 for drinks and din-ner. The lavish buffet set atop severalpool tables was completed by a flowingchocolate fondue station. The prize raffleincluded many gifts and the grand prizewinners were: Barb Cullen from Dr.Tahaney’s office (James Blunt Tickets)and Liz Aurelia from Dr. Aurelia’sOffice (Red Wings Tickets) and PamGotts from Dr. Wesley’s Office (RedWing Tickets).

The staff parties are always greatevents enjoyed by Endodontic Associatesstaff and the staff of their referring dentists.

We look forward to scheduling moreevents in the future. n

EndodonticAssociates Victory Ride

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“Quote of the Quarter

““Every man should use hisintellect, not as he uses hislamp in the study, only for his own seeing, but as thelighthouse uses its lamps,that those afar off on theseas may see the shining,and learn their way.”

- H.W. Beecher

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Fall 2006www.endodonticassoc.com

Dental emergencies are extremely com-mon. In a survey conducted in theUnited States, 12% of the populationhad experienced a toothache in the pre-ceding 6 months. Although there arevery few data available, irreversible pul-pitis (IP), characterized by acute andintense pain, is considered one of themost frequent reasons for patientsseeking emergency dental care.

IP is defined as an inflammatoryprocess in which the dental pulp hasbeen damaged beyond repair and willeventually become necrotic. Most com-monly, the inflammation of IP in vitalteeth occurs beneath a deep cariouslesion before bacteria reach the pulp.The process of IP may progress even inthe absence of the initiating irritant(e.g., dental caries). IP is considered animmune-system–mediated event. It ismost often not a result of a bacterialinfection of the pulp but, rather, ofinflammatory mediators.

The symptoms of IP constitute a con-tinuum. A history of spontaneous painis usual and can include an exaggeratedresponse to hot or cold that lingersafter the stimulus is removed. It mayoccur as a direct result of dental caries,a cracked tooth or after a traumaticinjury. The affected tooth is usually notsensitive to percussion, and palpationtests do not produce an untoward reac-tion. The customary way of relieving thepain of IP is by initiating endodontictreatment.

Nevertheless, some dentists will pre-scribe antibiotics to stop the pain of IP.The prescription of systemic antibioticsas a perceived means of relieving painin endodontic emergencies has receivedconsiderable attention. There appears tobe limited empirical evidence to sup-port the effectiveness of this approach,

The Use of Antibiotics for Pain Relief in Irreversible Pulpitis

and there have been questions raisedabout the safety of indiscriminateantibiotic prescription.

Keenan et al from the U.S. NavalHealth Clinics, United Kingdom, sum-marized a Cochrane Systematic Reviewof the effectiveness of antibiotics forpatients with IP. One of the studiesreviewed was an investigation of theindiscriminate prescribing of antibi-otics, commissioned by the BritishNational Health Service (NHS). Thisstudy confirmed that there was evi-dence of overuse and inappropriate pre-scribing of antibiotics in the NHS gen-eral dental practice, and antibioticswere frequently prescribed in clinicalsituations where there was limited evi-dence of benefit. Patient expectation(8%), pressure of time and workload(30%), and a patient’s social history(8%) accounted for a large number ofnonclinical factors responsible forantibiotic prescribing.

This finding appeared to be support-ed by an American Association ofEndodontists study, which indicatedthat some endodontists felt compelledto prescribe antibiotics for medicolegalreasons, to satisfy patient demand andexpectation, and to decrease the risk oflosing referrals. In addition, a double-blinded randomized clinical trial wasperformed by Nagle et al (2000) com-paring systemic penicillin with placebofor pain in untreated teeth with IP. Theyfound that the use of antibiotics is no

more effective than placebo in reducingpain associated with IP (Table 1).

ConclusionThe use of antibiotics in conjunctionwith cleaning and disinfection of theroot canal or dental extraction shouldonly be considered when the spread ofinfection is systemic and the patient isfebrile.

Keenan JV, Farman AG, Fedorowicz Z,Newton JT. A Cochrane systematicreview finds no evidence to support theuse of antibiotics for pain relief in irre-versible pulpitis. J Endod 2006;32:87-92.

Table 1. Sum pain and percussion pain intensity differences*

Pain/percussion Penicillin Placebo p valueSum pain intensity difference 6.0±10.5 6.0±9.5 .776Sum percussion pain intensity difference 3.5±7.5 2.0±7.0 .290

*Median and interquartile range

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Fall 2006

Administrative Office - 50 West Big Beaver, Bloomfield Hills, Michigan phone 248 647-7930For information or suggestions - contact Denise phone 248 647-7935 fax 248 647-6067 email djc2@endocentral.com

www.endodonticassoc.com

Endodontic Associates Clinton TownshipDoctors and staff hosted a lunch forreferring dentists and staff at J. Baldwinsin Clinton Township to to supportNational Breast Cancer Month. Evenwith bad weather, 140 supportersattended the event, which was held onWednesday, October 4th. EndodonticAssociates made a donation to theSusan G. Koman Breast CancerFoundation for every person that attended.“The event was very well supported,”Dr. Richard Somerlott said, “everybodyhas been touched by this tragic diseaseand we are honored to be part of theeffort to find a cure.” n

Fighting for a Cure

Many people believe that root-canaltreatment (RCT) is a very painful proce-dure, and some people would even pre-fer to have the tooth extracted. van Wijkand Hoogstraten from the AcademicCentre for Dentistry Amsterdam, theNetherlands, investigated whether thefear of pain associated with endodontictreatment could be reduced by provid-ing patients with a short piece of writ-ten information on endodontics that wasaimed at dispelling negative beliefsabout endodontic treatment by provid-ing positive knowledge.

A large sample (n = 437) was random-ly allocated to read 1 of 5 informativeparagraphs and afterwards asked tocomplete 2 questionnaires (on dentalanxiety and fear of dental pain). Theparagraphs consisted of dental informa-tion obtained from patient brochures.

Reducing the Fear of Pain Associated with Endodontic Therapy

One (experimental) paragraph consistedof positive information about pain dur-ing endodontic treatment. Analysis ofvariance followed by post hoc analysiswas used to detect differences in meanscore.

The results showed that fear of painduring endodontic treatment can bedecreased significantly by providingpatients with positive information.

Clinical implications are as follows:1. Patients can be accurately

informed about pain associatedwith endodontic treatment, and asa result, more compliant behaviormay occur (less avoidance);

2. The patient may be more at easebefore and during treatment; and

3. The patient can make a decisionregarding treatment choice that is

based on common sense ratherthan fearful expectations. Althoughother nonbehavioral techniques forreducing anxiety or fear exist,these do not address the problembut merely reduce the symptoms.

ConclusionThe clinical implication of this study isthat patients should be accuratelyinformed about pain associated withendodontic treatment. In this way, thepatient may be more at ease before andduring treatment, decrease avoidancebehavior and make decisions regardingtreatment choice based on commonsense, rather than fearful expectations.

van Wijk AJ, Hoogstraten J. Reducingfear of pain associated with endodontictherapy. Int Endod J 2006;39:384-388.

Endodontic Associates lost a long time partner(1969 - 1998), dear friend, and skilled clinician onWednesday, November 1, 2006, when Dr. JohnDylewski lost his long and courageous battle withcancer. His clinical skills and amiable mannermade him a highly sought after doctor and muchloved partner and employer. John is survived by hiswife Shirley, children Dr. Mark Dylewski a currentEA Partner, Paul (Allison), Gary D.O., SuzanneCowdon (David, M.D.) and 11 grandchildren. Johnwill be forever in the memory and prayers of every-one at Endodontic Associates. The Dylewski Familyhas suggested Angels’ Place, 25240 Lahser, Suite2,Southfield, MI, 48034, and Beaumont Hospice, 3601 W. Thirteen Mile Rd.,Royal Oak, MI, 48073, for contributions in his memory. n

In Memorium

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