4 NYSDJ • APRIL 2007
BY NOW, THE TERM EVIDENCE-BASED DENTISTRY has become
something of a cliché, having been bantered around in practically
every dental publication and in many ofthe presentations and forums
we attend. There is no doubt that the development ofclinical protocols
that are based upon meaningful investigations, investigations that
meet the “gold standard”of fundamental research design and imple-
mentation,is a priority on dentistry’s agenda.But this admirable quest
is fraught with potential problems and challenges,while still holding
out hope ofbenefits to both the dental practitioner and to our patients.
Identifying areas of clinical practice that merit further investi-
gation must rely upon input from clinicians themselves to maxi-
mize the benefits to individual patients and/or the profession at
large.The “so what?”criteria should be met so that measurable dif-
ferences that might potentially be found in clinical outcomes—if
that is what is being investigated—represent a meaningful state-
ment that could and should have an impact upon cogent recom-
mendations for changes in clinical treatment protocols.
The role of the clinician as an important member of the
research team now becomes more important than ever.As such,the
clinical dentist and dentist researcher/academic and biostatistician
must have an unprecedented dialogue and relationship.
Dental education on the predoctoral and postdoctoral levels
will also have an opportunity to broaden research design perspec-
tives and will be a significant benefit for all of us.While the ability
to critically assess the professional literature found in our peer
reviewed publications has always been and will continue to be an
important responsibility of all dentists, editors and editorial
boards, the expectations for clinician participation in small and
large research projects will undoubtedly be raised.
The National Institute of Dental and Craniofacial Research
(NIDCR) has taken a bold and proactive position in forging a new
model for clinical research in dentistry.Practice-based research net-
works (PBRNs) have been utilized in medicine,and this has result-
ed in significant clinical protocol changes. Similarly, the PBRN
structure,as envisioned by the NIDCR,is an inclusive concept that
combines the rigorous standards of academic research with the
practical demands of clinical practice.As such,the NIDCR commit-
ted approximately $75 million, over seven years, to three dental
PBRNs.Each PBRN will be mandated to recruit at least 100 general
dental practitioners as participants in the PBRN investigation pro-
jects.This unprecedented hybrid structure of clinical investigation
represents the ultimate meeting of“town and gown”in dentistry.
One of the three dental PBRNs is based in the Northeast and
was awarded to New York University College of Dentistry and The
EMMES Corp. from Rockville, Maryland. It is referred to as the
PEARL Network, an abbreviation for Practitioners Engaged in
Applied Research and Learning.I am certain we will be hearing a
great deal more about all of these dental PBRNs in the near future.
As the dental profession charts its course ofcontinued excellence
and relevance to the public in this millennium,clinical research will
play a powerful role in the process.Indeed,the rules of engagement
have been profoundly changed.What an exciting time for all of us!
Clinical Research in Dentistry
Everything is up for change, from research design to treatment protocols.
The times couldn’t be more challenging, or exciting.
NYSDJ • AUGUST/SEPTEMBER 2006 5
Stony Brook, NY 11790
NYSDJ • APRIL 2007 5
Steven Gounardes, President
351 87th St., Brooklyn 11209
Stephen B. Gold, President Elect
8 Medical Drive, Port Jefferson Station 11776
Michael R. Breault, Vice President
1368 Union St., Schenectady 12308
John Asaro, Secretary-Treasurer
2707 Sheridan Drive, Tonawanda 14150
Alfonso J. Perna, Immediate Past President
Sixth District Dental Society, 55 Oak St.
Roy E. Lasky, Executive Director
121 State St., Albany 12207
William R. Calnon, ADA Trustee
3220 Chili Ave., Rochester, NY 14624
NY County-Lawrence Bailey
215 W. 125th St., New York 10027
NY County-Matthew J. Neary
501 Madison Ave., Fl. 22, New York 10022
NY County-Robert B. Raiber
630 Fifth Ave., #1869, New York 10111
2-Michael L. Cali
2003 E. 60th St., #1A, Brooklyn 11234
2-Craig S. Ratner
1011 Richmond Rd., Staten Island 10304-2413
2-James J. Sconzo
1666 Marine Parkway, Brooklyn 11234
3-Lawrence J. Busino
2 Executive Park Dr., Albany 12203
3-John P. Essepian
180 Old Loudon Rd., Latham 12110
4-Mark A. Bauman
157 Lake Ave., Saratoga Springs 12866
4-Frederick W. Wetzel
1556 Union St., Niskayuna 12309
5-William H. Karp
472 S. Salina St., #222, Syracuse 13202
5-John J. Liang
2813 Genessee St., Utica 13501
6-Robert W. Baker, Jr.
412 N. Tioga St., Ithaca 14850
39 Leroy St., Binghamton 13905
7-Richard F. Andolina
74 Main St., Hornell 14843
7-Andrew G. Vorrasi
2005-A Lyell Ave., Rochester 14606
8- Jeffrey A. Baumler
2145 Lancelot Dr., Niagara Falls 14304
8- Kevin J. Hanley
959 Kenmore Ave., Buffalo 14223-3160
9-Malcolm S. Graham
170 Maple Ave., White Plains 10601
9-David H. Kraushaar
6 Woodthrush Drive, W. Nyack 10994
9- Neil R. Riesner
111 Brook St., 3rd Floor, Scarsdale 10583-5149
N- Peter M. Blauzvern
366 N. Broadway, Jericho 11753-2032
N-David J. Miller
467 Newbridge Rd., E. Meadow 11554
N-Robert M. Peskin
601 Franklin Ave., #225, Garden City 11530-5742
Q-Chad P. Gehani
35-49 82nd St., Jackson Heights 11372
Q-Robert L. Shpuntoff
28 Beverly Rd., Great Neck 11021
S-Paul R. Leary
80 Maple Ave., #206, Smithtown 11787
S-Steven I. Snyder
Suffolk Oral Surgery Associates, 264 Union Ave., Holbrook 11741
B-Stephen B. Harrison
1668 Williamsbridge Rd., Bronx 10461
B-Richard P. Herman
20 Squadron Blvd., New City 10956
BOARD OF GOVERNORS
James E. Spencer
2 Burlington Pl., Woodcliff Lake, NJ 07671
Mark J. Feldman
5 Vanad Dr., Roslyn 11576
Robert J. Herzog
16 Parker Ave., Buffalo 14214
Dental Benefit Programs
Ian M. Lerner
One Hanson Pl., #2900
Brooklyn, NY 11243-2907
Dental Health Planning/
Robert A. Seminara
281 Benedict Rd., Staten Island 10304
Brendan P. Dowd
6932 Williams Rd., #1900, Niagara Falls 14304
Dental Education & Licensure
Madeline S. Ginzburg
2600 Netherland Ave., #117
Kevin A. Henner
163 Half Hollow Rd., #1
Deer Park 11729
Joseph R. Caruso
40-29 Utopia Pky., Flushing, 11358
Roland C. Emmanuele
4 Hinchcliffe Dr.,
Newburgh, NY 12550
Deborah A. Pasquale
391 Manhattan Ave.,
David C. Bray
18 Leroy St., Binghamton 13905
Alfonsa J. Perna
Sixth District Dental Society
55 Oak St., Binghamton, NY 13905
Peer Review &
1 Rockefeller Plaza., #2201,
New York 10020-2003
Anthony V. Maresca
207 Hallock Rd.
121 State Street
Albany, NY 12207
Roy E. Lasky
Margaret Surowka Rossi
Michael J. Herrmann
Assistant Executive Director
Judith L. Shub
Assistant Executive Director
Mary Grates Stoll
Beth M. Wanek
Assistant Executive Director
Foundation to Recognize
Annual Deans Award aimed at bolstering oral
health workforce in New York State.
ENSURING A GROWING and sustainable oral
health workforce is crucial to expanding the
availability of oral health services to all New
Yorkers, particularly the underserved and mem-
bers of the state’s growing culturally diverse
communities. To help address this critical issue,
the New York State Dental Foundation has estab-
lished a Deans Award, which will be present-
ed annually to graduating students or post-
doctoral trainees who have demonstrated an
exceptional level of achievement as measured
by the following criteria:
Outstanding academic performance.
A demonstrated commitment to enhancing
and improving the oral health of under-
Membership in the American Dental Student
Candidates for the NYSDF Deans Award,
valued at $5,000, must be nominated by the
dean of each of the following academic dental
institutions: Columbia University College of
Dental Medicine; New York University College
of Dentistry; University at Buffalo School of
Dental Medicine; Stony Brook University
School of Dental Medicine; and the University
of Rochester Eastman Dental Center. Upon
review by the Foundation Board, the deans'
candidates will each be presented with a
$5,000 check at their respective commence-
“This is such a wonderful opportunity for
the Foundation to partner with the state’s den-
tal schools,” said Foundation Chair Edward J.
Downes. “At the same time, we are promoting
the value of organized dentistry, making this
new program a remarkable win-win for every-
Winners of the 2007 Deans awards are
expected to be announced soon.
12 NYSDJ • APRIL 2007
THE BOARD OF TRUSTEESofthe New York State Dental Foundation
has approved a request for funding in the amount of$10,000 from the
Chemung County-Corning Coalition for Water Fluoridation.
The Chemung County-Corning Coalition for Water Fluori-
dation is an affiliation of advocates for completion of the 25-mile
corridor of municipal water fluoridation from Chemung County to
Painted Post.The eastern portion ofChemung County has been flu-
oridated since 1953, a system that currently serves 70,000 of the
92,000 residents of the county.To the west,Painted Post has fluori-
dated since 1976,serving 9,100 residents.In the intervening years,
from initial fluoridation to today, many studies have shown that
children in the non-fluoridated 25-mile corridor exhibited elevated
numbers of decayed,missing and filled teeth.
Following a decades-long struggle against vitriolic anti-fluori-
dationists, public health advocates were able to successfully lobby
the Corning Board of Health and the Corning City Council to agree
to fluoridate the remaining water supply.The one catch was that the
Chemung County-Corning Coalition for Water Fluoridation would
have to come up with $100,000, half of the capital costs to start
water fluoridation, hence, the request for funding from the New
York State Dental Foundation.
“We were greatly impressed by the level of support garnered
for this project from all possible stakeholders but most notably
from the local dental communities,” said Foundation Vice
Chairman Robert Raiber.By the time the coalition made its appeal
the NYSDF, it had already received $11,000 in pledges from indi-
vidual,local dentists; a $2,500 donation from the Steuben County
Dental Society; and a $10,000 donation from the Seventh District
Dental Society. In addition, the Ferraioli Dental Lecture has
Among the NYSDF’s missions is the goal of increasing public
understanding of and access to dental services. Clearly, fluorida-
tion is an essential aspect of oral health. The Centers for Disease
Control has called fluoridation one of the 10 greatest public health
achievements of the 20th century.In its “MMWR Weekly,”the CDC
“Fluoridation of drinking water began in 1945 and in 1999
reached an estimated 144 million persons in the United States.
Fluoridation safely and inexpensively benefits both children and
adults by effectively preventing tooth decay, regardless of socioeco-
nomic status or access to care.Fluoridation has played an important
role in the reductions of tooth decay (40% - 70% in children) and of
tooth loss in adults (40% - 60%).”
The Foundation commends the hard work and efforts of the
Chemung County-Corning Coalition for Water Fluoridation and is
thankful for the opportunity to support and assist efforts to
improve the oral health of all New Yorkers.
Foundation Honors Eisenbud
The Board of Trustees of the New York State Dental Foundation
recently honored the memory and outstanding achievements of Dr.
Leon Eisenbud,with a contribution of $1,000 to a campaign to ren-
$10,000 for Fluoridation
NYSDJ • APRIL 2007 13
ovate and rename the dental department at Long Island Jewish
Medical Center in his honor.
“Dr. Eisenbud,” said Foundation Chair Edward Downes,“will
long be remembered by members of our Board as well as the lead-
ership of the New York State Dental Association as the ‘father of the
modern dental residency program.’”
In a letter written in the fall of 2002 to NYSDA Executive
Director Roy E.Lasky,Dr.Eisenbud called passage ofthe PGY-1 leg-
islation “a grand achievement”and referred to the State Board exam
process as “archaic and unfair”:
“…I am writing now to congratulate you on this grand
achievement,which indeed was only a dream.The substitution of a
residency for the unfair and archaic state board exam is the most
important step forward for the profession in my lifetime.I congrat-
ulate you because I know the way you guide things through the leg-
islative system. I think maybe this would not have happened with-
“Dr. Eisenbud’s impeccable reputation and his ability to
instruct and inform others without a doubt helped NYSDA in its
efforts to remove the exam requirement in New York State,” Dr.
A committee has been formed at Long Island Jewish Medical
Center to spearhead the campaign to rename the dental department
in Dr.Eisenbud’s memory.It is the committee’s hope that everybody
in the dental community will do what he or she can to ensure that
Dr.Eisenbud’s legacy will be appropriately memorialized. ■
H O N O R I N G
Excellence in Community Service
& Corporate Leadership
Save The Date
FOUNDATIONS OF EXCELLENCE
Friday October 12, 2007 12:00 noon to 2:00 p.m.
The St. Regis Two East 55thStreet At Fifth Avenue, NYC
14 NYSDJ • APRIL 2007
A NEW AND EXCITING TRENDin dental research is embodied by
the inauguration of three practice-based research networks funded
by the National Institute for Dental and Craniofacial Research, an
arm of the National Institutes of Health. One is based in the
Northwest,a second in the Southeast,and the third,closer to home,
at the New York University College of Dentistry. This last, the
PEARL Network— PEARL stands for Practitioners Engaged in
Applied Research and Learning—has since its inception in 2005
enrolled more than 100 practitioner-investigators and has eight
studies either underway or in the planning stages.
Practice-based research networks (PBRNs),which have exist-
ed in the United States since the 1980s but until recently only
among physicians,generate research of immediate relevance to the
profession by combining the expertise of a central academic
research center with the savvy of the practitioner working “in the
trenches.”The PBRN concept arose from recognition ofthe fact that
while the majority of clinical research is conducted in academic
health centers,only a minority of patients receive their medical or
dental care there.
In contrast,in the PBRN model,network participants—clini-
cians involved in private practice, who represent 70 percent of the
profession—submit their own ideas for research to a coordinating
academic center,where NIH-approved protocols are developed and
in turn are implemented by these same practitioners.Improvements
in clinical practice traditionally have proceeded in a top-down man-
ner: a study begins in a laboratory or academic site and ends at an
academically based faculty practice.The PBRN model seeks to com-
plement this process by including the primary means of achieving
the greatest impact in terms of change:the general practitioner.
The PBRN model furthermore seeks to make up for the lack of
data available for clinical decision making and to create a mecha-
nism for comparing clinical outcomes reported by practitioners
who have decades of experience with findings generated by acade-
mic research centers.
Dentists Make Good Candidates
In terms of the practical implementation of such a model,experi-
ence has demonstrated that private-practice dentists and their
office staff are uniquely suited to participate in network-based
research,for several reasons.They include the following:
● The research focus of PBRNs is primarily problem based.
● Dentists are trained to be detail oriented and in control of the
● The essential elements of clinical research are mirrored by the
dentist’s experience with implementing a treatment plan.
● Dedicated private-practice staff are familiar with the team
approach to clinical care, which parallels the environment
required for research coordination.
A typical dental PBRN study may last anywhere from one
month to three years,although most are of six months’duration.It
is an observational study that addresses a fundamental clinical
question:Why we do what we do; and how can we do it better? All
studies relate to the day-to-day clinical needs of private dentists
and their patients and involve minimal additional work on the part
of the practitioner. Current topics under investigation by NYUCD
PEARL Network practitioner-investigators,for example,include:
Practice-Based Research Networks
A Win-Win for Private-Practice Dentists and the Future of Dentistry
Analia Veitz-Keenan,D.D.S.;Gary S.Berkowitz,D.D.S.;Irene Brandes,D.D.S.,P.C.;
Kenneth L.Goldberg,D.M.D.;David A.Hamlin,D.M.D.;Robert Margolin,D.D.S.;Kay Oen,D.D.S.
P E R S P E C T I V E S
NYSDJ • APRIL 2007 15
● Causes of postoperative hypersensitivity in Class I composite
● The effects of partial vs. complete caries removal on patient
Studies in the planning stages deal with:
● The effects of endodontic therapy and restoration on tooth
● The effects ofsealing vs.restoration on caries extending into dentin.
Time Well Spent
While the individual dentist’s involvement in a PBRN involves a
substantial personal commitment of time and effort,most practi-
tioner-investigators regard the rewards of their participation as
more than commensurate.For example:
● Participation in cutting-edge research has a positive impact on
the practitioner-investigator’s practice in addition to leading
to improvements in the practice of dentistry.
● The Network practitioner-investigator gains training in the
methods and ethics of clinical research from specially trained
Network personnel—a “gift that keeps on giving.”
● Network administration assumes the burden of paperwork
necessary for study approval and reporting,thereby freeing up
the practitioner-investigator to concentrate on the nuts and
bolts of the study.
● The private-practice dentist,who is typically isolated from the
research environment, enjoys a new collegiality with other
practitioner-investigators, with a prestigious academic center
and with NIH. The PBRN acts as a link connecting dental
offices,integrating these offices into a larger organization and
uniting practitioners and academic researchers.
● Participation in a Network study helps satisfy the practition-
er’s continuing education requirements.
More and more dentists are viewing PBRNs as a means for becom-
ing involved with the advancement of the profession by applying
scientific guidelines to generate significant—and practice-applica-
ble—clinical data. PBRNs function at the interface between
research and quality improvement.They have the potential to have
a substantial impact on dentistry by adding a learning dimension
to the dental practice while improving primary dental care and cre-
ating a connected learning community.They provide opportunities
to address patient-centered issues that previously were neglected.
The ultimate measure of the success of dental PBRNs will be
their ability to influence dentistry,to change clinical procedures on
the basis of objective and reproducible evidence gathered by multi-
ple practitioners representing a wide range of patients, clinical
expertise and office locations. ■
The authors are all practitioner-investigators in the PEARL network and members of
the PEARL Practitioner Advisory Group.More information on the PEARL Network
is available at http://www.pearlnetwork.org/
16 NYSDJ • APRIL 2007
THE DENTAL SCHOOL OF COLUMBIA UNIVERSITY officially
opened on September 27, 1916, with a combined MD/DDS pro-
gram. Dr.Joseph Schroff was the first recipient of a dental degree
from Columbia,in 1922.
Fast forward almost 100 years and we are witness to outstand-
ing contributions to the dental profession by the teachers and gradu-
ates of what is now Columbia University College of Dental Medicine.
TheNYSDJhad an opportunity to visit with Ira Lamster,D.D.S.,M.M.Sc.,
dean ofthe College ofDental Medicine.In the interview that follows,Dr.
Lamster illuminates Columbia University’s unique approach and com-
mitment to dental education,research,clinical training and communi-
ty service in an ever-changing and complex health care environment.
Dr. Moskowitz: You have been dean of the Columbia University
College of Dental Medicine for approximately five years. How are
you enjoying the job?
Dean Lamster: I enjoy my job immensely. I am fortunate to
work with a fine faculty,who are intelligent and dedicated.Our den-
tal students and postdoctoral students are very bright and motivat-
ed.In addition,the College of Dental Medicine is positioned within
the Columbia University Medical Center,which is a remarkably col-
laborative institution with many outstanding health care scientists
and clinicians in medicine,public health and nursing.Many of our
academic,research and patient care programs occur in the context
of the health sciences, and that is the best position for a dental
school to be in. The job of dean has its challenges, and there are
many demands on your time and energy.This is not a job you can
do effectively unless you believe in your school.
Dr.Moskowitz:Are there any special challenges for Columbia
University College of Dental Medicine because of its location in a
large urban area?
Dean Lamster: Being in an urban setting provides challenges
and opportunities. The patients we serve are often those who have
difficulty accessing services,and they present with a significant dis-
ease burden.On the other hand, there is enormous satisfaction for
our trainees when they provide a service that changes a person’s abil-
ity to function or smile.In addition,we have a large pediatric den-
tistry service,and starting children in the right direction is a major
accomplishment that can prevent a lifetime of dental problems.
Dr. Moskowitz: Historically, deans of dental schools have
been somewhat inaccessible or, at least, not terribly visible to the
profession at large.You,however,are very visible in the dental pro-
A CONVERSATION WITH IRA LAMSTER
Dean of Columbia University College of Dental Medicine talks about challenges
and rewards of sitting at the helm of one of America’s premier dental schools.
Editor,The New York State Dental Journal
NYSDJ Editor Elliott Moskowitz, left, discusses issues facing dental education with Columbia University College of Dental Medicine Dean Ira Lamster.
NYSDJ • APRIL 2007 17
fession.You attend dental meetings,on the local,state and national
levels,scholarly forums and associated social functions. How does
this visibility and accessibility help you in your role as dean?
Dean Lamster:It is important for a dean of a dental school to
acknowledge his or her constituency. At many of the meetings I
attend,I see our faculty and alumni.It is important to be a part of
these events.As with all of us,by being there,I can demonstrate my
feelings about the importance of an organization or a particular
meeting.I am still involved in research and still have an active NIH
grant. That is a part of my professional life, but demands on my
time are making this difficult to maintain.
Dr.Moskowitz: What is your vision for Columbia in the next
Dean Lamster: The Columbia University College of Dental
Medicine is uniquely positioned to bridge the gap between medi-
cine and dentistry.I appreciate the fact that dentistry is a distinct
profession but with close ties to medicine; therefore, defining our
role in the health care system is a critical goal for the future.We see
our predoctoral program evolving into training that allows greater
time for electives and for more interactions with medicine and
public health.We are continuing to expand our offsite clinical care
initiatives,as well as our research initiatives that look at dental and
craniofacial research in the context of health sciences research.
Dr. Moskowitz: What differences do you see in the student
body at Columbia today as compared to previous eras?
Dean Lamster:Our student body is truly outstanding.Like all
dental schools in the United States,Columbia is seeing a large num-
ber of applicants.And those accepted are among the finest students
applying to dental school.They come to us with a variety of experi-
ences prior to entering the college.Many are interested in what we
can think of as nontraditional careers, including academics,
research, business—we have a combined DDS/MBA program—
and public health/public service—we also have a combined
DDS/MPH program.Further,many of our students understand the
importance of community service and act on those beliefs while at
Dr. Moskowitz: Columbia has always been identified with
having a strong connection to the surrounding community.What is
so special about this relationship?
Dean Lamster: This effort is special because it acknowledges
that the college considers patient care to be an equal mission with
training and research.Our connection to the surrounding commu-
nity formally began in 1996 with formation of the DentCare pro-
gram, which focused on delivery of dental services to children in
the community.This was accomplished through the establishment
of small clinics in local schools or through affiliations with com-
munity health centers.More recently,we developed the ElderSmile
program, which focused on the oral health care needs of older
adults.The patient care component of that program includes visits
to what we term prevention sites,often located in senior centers.We
provide both oral hygiene education and screenings for attendees.
Individuals in need of services are then referred to a number of
community treatment centers that specialize in providing dental
services to older adults.
Dr.Moskowitz: What role do your alumni play in the overall
workings of the dental college?
Dean Lamster:The alumni play a very important role.First,a
significant percentage of our full-time, part-time and volunteer
faculty are alumni of the predoctoral and/or postdoctoral pro-
grams.Second,the alumni support the school in a variety of ways
besides serving on the faculty.For example,they participate in our
continuing education program as lecturers and presenters; they
contribute to our annual fund;and we are soon to announce a new
capital campaign.They have helped the campaign get off to a fine
start. In addition, I am continuously impressed with the accom-
plishments of our alumni.We have started to feature these individ-
uals and their accomplishments in our alumni magazine Primus
and our alumni newsletter Primusnotes.
Dr. Moskowitz: What makes Columbia University College of
Dental Medicine different from other dental institutions?
Dean Lamster:We have redefined the predoctoral curriculum
on the basis of three tenets. First, our dental students take their
basic science courses with the students at the College of Physicians
and Surgeons.Second,we stress the critical importance of postdoc-
toral education, be that a general practice residency or an AEGD
program or a specialty program. In fact, over the past few years,
more than 97% of our students have continued their education.
Third,we have made dual-degree training an important part of our
Dental school at Columbia University, in New York City, awarded first dental degree
in 1922, six years after it opened.
18 NYSDJ • APRIL 2007
curriculum.These offerings include DDS/MPH and DDS/MBA pro-
grams, as well as a newly introduced DDS/MA in education with
our Teacher’s College. This is intended for those interested in an
academic career.We have also just started our first DDS/PhD pro-
gram,in Bioinformatics.Similar changes are being introduced into
the postdoctoral/residency programs.
In addition,our place within the Columbia University Medical
Center makes us one of only a few dental schools that are truly inte-
grated into their health sciences campus.As you know, we do not
have our own building,but,rather,we have floors within the Medical
Center. This promotes collaboration with the medicine, public
health and nursing programs on a variety of levels.
Dr. Moskowitz: Dental schools tend to be somewhat insular
with respect to other parts of their universities.What is the rela-
tionship between the College of Dental Medicine and other colleges
within Columbia University?
Dean Lamster:That is not the case at Columbia.While we and
the other CUMC schools are physically separated from the 116th
Street campus,we are clearly part of Columbia,and the ties between
the campuses continue to grow. For example, one of our faculty
members is the co-chair of the Columbia University Diversity
Council for the professional schools.Our faculty is also involved in
the new CTSA grants for clinical research funded by NIH;and one of
our junior faculty received a K12 award through that program. In
addition, we have a robust research program with Biomedical
Engineering,which is located primarily on the 116th Street campus.
There are other examples,but you can see the pattern.
Dr.Moskowitz: How are you preparing your predoctoral stu-
dents and postdoctoral residents to cope with an increasingly com-
plex health care environment?
Dean Lamster:We feel the environment here at the college is
the best teacher.That is,we see dentistry as an integral part of the
health sciences environment,and our predoctoral students,post-
doctoral students and hospital residents learn from the outset
that they are treating a patient and not just a set of dental prob-
lems. We also have developed a “curricular map,” which defines
the four years of the curriculum into basic,behavioral and clini-
cal tracks so the students can see how these three components fit
together. There is also time in the curriculum for discussion of
larger issues facing the dental profession,including access to care,
dental health care services for older adults and understanding the
current role of the profession, as well as the possibilities for the
future. Just today, I heard a report on our efforts to introduce
smoking cessation into the predoctoral program. This program
has made great strides in the past three years,and we believe that
our graduates will incorporate this aspect of primary health care
into their practices.
We are fortunate to attract an excellent group ofdental students,
postdoctoral students and residents.They are well read and socially
conscious when they come to us.We try to nurture that attitude.
Dr. Moskowitz: Funding is always a critical issue in private
academic institutions.How does Columbia manage this situation?
Dean Lamster: The economics of a private dental school are
challenging.We are structured so that we are not too dependent on
any one source or revenue. Tuition accounts for only one-third of
our budget, with clinical income accounting for 40%, and 25% is
everything else, including research, extramural programs and
fund-raising activities.Each school within Columbia budgets in a
similar manner. We capture all of our income, including tuition,
clinic fees and all direct and indirect costs associated with grants.
In turn, we pay a “common cost” to both the University and the
Dean Lamster presides over one of regularly scheduled lunch meetings with small groups of second-year predoctoral students. From left: students Helen Park and
Charles Yau; Dean Lamster; student Phillip Mann; NYSDJ Editor Elliott Moskowitz.
NYSDJ • APRIL 2007 19
Dr. Moskowitz: How do you balance allocating resources for
scholarly academic matters and clinical areas?
Dean Lamster: This is one of the most challenging parts of
the job.There are many good ways to spend money—new clinical
faculty, adding additional research faculty, construction of new
facilities,a new clinic information system,to name a few.I rely on
the faculty,and,in particular,the senior faculty,to help guide these
decisions.Over the past few years,we have added to the clinical fac-
ulty and recruited new research faculty who are engaged in collab-
orative research across the Medical Center and the University. In
addition, we have built new research laboratories and renovated
some clinical areas.We are now constructing a new faculty practice
on the Medical Center campus.Our next task is to renovate one of
our main clinical floors.So,I guess the response to your question is
Dr. Moskowitz: Where do ethics fit into the curriculum of
your Columbia students? What special challenges do you see in this
Dean Lamster: Maintaining ethical standards is a challenge
for the professions and for society in general.We recently revamped
our ethics program and now include instruction in ethics in all four
years ofthe curriculum.In fact,ethical behavior is addressed at ori-
entation for the new first-year students and is reinforced during
that week with the White Coat Ceremony.We have also established
an Ethics Committee for the College,with representation from the
senior and junior full-time faculty, the part-time faculty and the
Dr. Moskowitz: Can you tell me if there are any significant
problems in attracting our younger colleagues to either full-time or
part-time faculty positions? And if so,why?
Dean Lamster: In the past few years,we have increased the
full-time faculty by 10%. For the most part, these have been
recent graduates who have completed their specialty training or
completed a general practice residency. They are engaged in
teaching, research and clinical care. These are terrific people
who are joining the full-time faculty for the right reasons.They
enjoy teaching and do it well,and are enthusiastic about an aca-
demic career. Many, but not all, are Columbians. I believe we
have opened our students’eyes to the advantages of an academ-
ic career, in part by offering dual degree programs—we now
even have a DDS/MA joint degree program with the Teacher’s
College. I would like to see more young graduates joining the
Dr.Moskowitz:What would be some incentives for motivating
our colleagues to return to their alma mater as either part-time or
Dean Lamster: There are many reasons to join the volun-
teer faculty.First,as we know,the dental profession is attracting
excellent students. It is rewarding to be involved in their educa-
tion.Second,serving on the volunteer faculty provides opportu-
nities for professional interaction that may not be available to the
full-time clinician. Third, it is the right thing to do. Dental
schools need volunteer faculty. Members of our profession have
realized many terrific advantages as a result of their education.
We should be giving back so our dental schools remain strong
Dr. Moskowitz: Academic institutions and the American
Dental Association have not always worked harmoniously.How can
each support the other’s efforts?
Dean Lamster: I agree that the dental schools and the ADA
have not always worked well together.If one steps back to examine
the situation, there are many reasons why we should work well
together.We are educating the future members of the ADA,and we
can do more if we work together to address problems faced by the
profession.We have, however, developed a good working relation-
ship with the New York State Dental Association. The four dental
schools in New York—Columbia, NYU, SUNY Buffalo and SUNY
Stony Brook—along with the Eastman Dental Center at the
University of Rochester,a graduate dental institution,work togeth-
er on projects of mutual interest through the New York State
Academic Dental Centers group.We often work with NYSDA, and
we have found that we have common goals.A mutual respect has
developed,and I anticipate that this collaboration will continue to
expand in the future.
Dr.Moskowitz:I want to thank you for allowing The NYSDJto
interview you.You have provided us with valuable and interesting
insight into the educational mission of Columbia University and the
challenges of being dean of such a unique academic institution. ■
College of Dental Medicine, on 168th Street, is positioned within Columbia
University Medical Center. Mix of patients seen at College reflects its urban setting.
20 NYSDJ • APRIL 2007
The purpose of this study was to determine the extent of bac-
terial contamination of toothbrushes after use and the efficacy
of chlorhexidine and Listerine in decontaminating tooth-
brushes. The effectiveness of covering a toothbrush head
with a plastic cap in preventing contamination was also eval-
uated. It was found that 70% of the used toothbrushes were
heavily contaminated with different pathogenic microorgan-
isms. Use of a cap leads to growth of opportunistic microor-
ganisms like Pseudomonas aeruginosa, which may cause
infection in the oral cavity. Overnight immersion of a tooth-
brush in chlorhexidine gluconate (0.2%) was found to be
highly effective in preventing such microbial contamination.
THE USE OF ORAL CLEANING INSTRUMENTS,such as a tooth-
brush and dental floss, is essential for removing dental plaque, a
contributor to dental caries and periodontitis. Although various
types of toothbrushes and methods of toothbrushing are
described, procedures required for maintaining their cleanliness
are addressed infrequently.
The concept that toothbrushes are contaminated after use was pro-
posed as early as 1920 by Cobb,1who implicated the contaminated
toothbrush as a cause of repeated infections of the mouth.
Microorganisms can gain entry into a toothbrush from the oral
cavity or from the external environment,such as contaminated fin-
gers, aerosols from toilet flushing and bacteria present in moist,
humid conditions found in the bathroom.
Various studies1-6have reported contamination of toothbrush-
es with microorganisms and have recommended methods of
decontamination.However,no studies have been conducted to find
out the effectiveness of covering the toothbrush head with a plastic
cap in reducing/preventing contamina-
tion, as claimed by various toothbrush
manufacturers. Also, literature is scarce
on the effectiveness of Listerine, a com-
monly used mouthwash in decontaminat-
Therefore,the present study was con-
ducted to determine the level of contami-
nation in used toothbrushes that were
kept open and toothbrushes whose heads
were covered with a plastic cap (Figure 1).
Further, the effectiveness of chlorhexi-
dine and Listerine in decontaminating
used toothbrushes was evaluated.
Bacterial Contamination and Decontamination
of Toothbrushes after Use
Abhishek Mehta,B.D.S.;Peter Simon Sequeira,M.D.S.;Gopalkrishna Bhat,Ph.D.
Figure 1. Different tooth-
brushes tested for contam-
Material and Methods
For the present study, the subjects selected were students from a
hostel,so the environmental conditions were similar.Students who
had open carious lesions, severe gingivitis and throat infections
were excluded from the study.Ten individuals,aged 24 to 27,were
selected, and written informed consents were obtained. Two
unused toothbrushes (control) were cultured to check for any
microbial growth in packed toothbrushes before starting the study.
The study was conducted in three phases.In all three phases,
each lasting one week, subjects were provided with a
brand new toothbrush and were instructed to brush
with it twice daily and rinse it in running tap water for
at least 30 seconds.The toothpaste used by all the sub-
jects was the same.
In the first phase,subjects were instructed to keep
their toothbrushes in the open air for drying after use.
In the second phase,retrieved brushes were immersed
in either a 0.2% solution of chlorhexidine gluconate
(ICPA Health Products, India) or Listerine (Pfizer, Ltd., USA)
mouthwash for 12 hours by the investigator.
In the third phase,a new toothbrush,whose head
was covered with a plastic cap, was given.Along with
the instructions given in the previous phases,subjects
were told to keep the toothbrush head covered with a
plastic cap after every use.
Used toothbrushes were recovered after one week
in each phase and were transported in separate sterile
test tubes with a cotton plug for microbiological analy-
sis.The handle of the toothbrush was disinfected with
a surgical spirit and the head part was immersed in 10
ml of phosphate buffered saline (PBS) and vortexed for
five minutes to dislodge the bacteria. Serial 10-fold
dilutions were made and 10 µl was spread on a blood
agar plate.The inoculated plates were incubated at 370
for 24 hours.Colony count was determined and bacte-
ria were defined by standard procedures.7PBS (0.1 ml)
was inoculated into 10 ml of tryptic soy broth and
incubated at 370
oC for 24 hours and observed for any
In the first phase, bacterial contamination was
observed in 7 of the 10 tested toothbrushes. Staphy-
lococcus aureus, Viridans streptococci, S. epidermidis
and Acinetobacter spp were isolated (count >10 5 cfu /
ml) (Table 1).
In the second phase,immersion ofused toothbrush-
es (n=5) in chlorhexidine gluconate (0.2%) could kill
bacteria.Listerine was found to be less effective,as two of
the five brushes showed microbial growth (Table 2).
In the third phase, where a plastic cap-covered toothbrush was
given, 7 out of 10 toothbrushes showed microbial contamination.
Pseudomonas aeruginosa and Klebsiella spp were isolated from six
toothbrushes and one toothbrush, respectively (Table 3). None of
the packed toothbrushes (control) showed microbial growth.
Toothbrushes can get contaminated easily during their use.Reten-
tion of moisture and the presence of organic matter that has come
NYSDJ • APRIL 2007 21
T A B L E 3
Bacterial Contamination of Toothbrushes with Cap
Serial No. of ToothbrushBacterial Contamination Bacteria
T A B L E 1
Bacterial Contamination of Toothbrushes after Use
Acinetobacter spp, S. aureus, Viridans streptococci
Acinetobacter spp, S. aureus, Viridans streptococci
Acinetobacter spp, S. epidermidis
Acinetobacter spp, S. aureus
Acinetobacter spp, S. aureus
Acinetobacter spp, S. aureus
Acinetobacter spp, S. aureus
T A B L E 2
Effect of Antiseptics on Decontamination of Toothbrushes
Serial No. of
Treatment with ChlorhexidineTreatment with Listerine
from the mouth may promote growth of microorganisms on the
toothbrush bristles. Such contamination may lead to colonization
of microorganisms in the mouth and possibly infection. It is also
possible that contamination of toothbrushes can occur through
In the present study, microbial contamination was seen in 7
out of 10 toothbrushes (70%), whereas some previous studies
found microbes on all of the tested toothbrushes.2-5Predominant
microorganisms isolated were Acinetobacter spp, S. aureus, S. epi-
dermidis andViridans streptococci. This is in agreement with most
similar studies.2-4The bacteria were present in count >10 5 cfu / ml,
which is the infective dose for many bacteria.A previous study also
could show similar rates of bacterial contamination in toothbrush-
es after use.3
In the present study,chlorhexidine was found to be effective in
disinfecting contaminated toothbrushes. These results are consis-
tent with previous reports.2-4However,one of the previous studies
showed that Listerine was more effective.1The higher efficacy of
chlorhexidine could be the result of the extended spectrum of
action. Also, it is relatively non-toxic, odorless and is commonly
used as a mouthwash.These properties may make chlorhexidine a
good choice for disinfection of contaminated toothbrushes.
Before commencement of the study, two packed test tooth-
22 NYSDJ • APRIL 2007
brushes were cultured to check for the presence of any microorgan-
isms.No microbial growth was reported from either of the brushes.
This shows that contamination came from the external environment.
We found no clinical studies reporting levels of microbial con-
tamination of toothbrushes whose heads can be covered with plas-
tic caps.In our study,we found that the use of a plastic cap leads to
the growth of microorganisms like Pseudomonas aeruginosa, a
gram negative aerobe and opportunistic pathogen.Therefore,it is
not advisable to cover a toothbrush head with a plastic cap.Use of
a cap may help retention of moisture that promotes growth of P.
1.Caudry SD,Klitorinos A,Chan ECS.Contaminated toothbrushes and their disinfection.
J Can Dent Assoc 1995;61:511-15.
2. Suma Sogi HP,Subbareddy VV,Shashi Kiran ND.Contamination of toothbrush at differ-
ent time intervals and effectiveness of various disinfecting solutions in reducing the
contamination of toothbrush.J Ind Soc Pedo Prev Dent 2002;20:81-85.
3.Bhat SS, Hedge KS, George RM. Microbial contamination of toothbrushes and their
decontamination.J Ind Soc Pedo Prev Dent 2003;21:108-112.
4. Filho PN,Macari S,Faria G,Assed S,Ito IY.Microbial contamination oftoothbrushes and
their decontamination.Paediatric Dent 2000;22:381-4.
5.Taji SS, Rogers AH. The microbial contamination of toothbrushes. A pilot study. Aust
Dent J 1998;43:128-30.
6.Kozai K,Iwai T,Miura K.Residual contamination of toothbrushes by microorganisms.J
Dent Child 1989;56:201-4.
7.Collee JG, Fraser AG, Marmion BP, Simmons AS. Mackey and McCartney. Practical
Medical Microbiology.14th Edition.New York:Churchill Livingstone.1996.
24 NYSDJ • APRIL 2007
A simplified technique for recording maxillomandibular
relations in complete dentures is described. This tech-
nique enables the practitioner to construct a mandibular
occlusal mini-rim directly in the mouth, to adjust it to the
required vertical dimension and to record the maxillo-
mandibular relations during a single appointment. The
mandibular record is formed with wax, used to hold the
occlusal vertical dimension anteriorly, and impression
plaster, to record the centric relation posteriorly.
THE ACCURACY OF maxillomandibular relations is of utmost
importance in the construction of complete dentures. The use of
such dentures is highly dependent upon a correct centric relation
record,1especially during the first post-insertion months.2
Several methods have been described to record maxillo-
mandibular relations for the fabrication of complete dentures.
These include the use of extraoral and intraoral3tracing devices
(Gothic arch), which require additional clinical time, complicated
instrumentation and a high level of skill. They also include the
swallowing procedure, using the soft wax (cones) recording as
described by different authors.4,5However,some authors have ques-
tioned the validity of the swallowing procedure in determining the
reference position in the sagittal plane for the maxillomandibular
relationships of complete dentures.6
Of these techniques,the direct interocclusal records using the
occlusal rims (wax or plastic modeling impression compound) on
record bases remains the most popular technique,7even though it
still needs considerable clinical time to adjust the height of the
occlusal rims to match the desired vertical height of the face.
Several materials have been used to record maxillomandibular
relations in edentulous patients,but impression plaster has gained
in popularity because of its accuracy and repeatability.8,9,10
This technique consists ofpreparing the record bases (Formatray,Kerr
USA, Romulus, MI) with the maxillary occlusal rim only prior to the
appointment. The height and orientation of the maxillary rim
should be adjusted in the mouth as per the conventional methods
(that is,the occlusal plane parallel to the camper plane).
The vertical dimension measurements should be performed
according to the preferred methods—the phonetic “emma”and the
respiratory methods are typically used. The occlusal vertical
dimension (OVD) will be the difference between the rest vertical
dimension (RVD) and the interocclusal rest space.
The next step should consist of lubricating the maxillary rim
with petroleum jelly and putting a drop of wax on the middle of the
SIMPLIFIED METHOD FOR RECORDING
Maxillomandibular Relations in Complete Dentures
NYSDJ • APRIL 2007 25 Download full-text
posterior border of the maxillary rim to indicate the position of the
tip of the tongue during closure in centric relation.
A deeply softened wax wafer,in wet heat preferably (Cavex Set Up
regular modeling wax, Cavex Holland B.V., Haarlem, the Netherlands), should
then be prepared and fixed in the anterior region of the mandibu-
lar base using a hot spatula (Figure 1).However,in extreme angle
Class II jaw relationship cases,the mandibular mini-rim would be
extended to the first premolar region for better stability of the
occlusal rims during the recording.
Both record bases should be inserted in the mouth and the
mandibular occlusal mini-rim arranged in such a way that its
direction closely meets the maxillary rim.The patient should then
be asked to put the tip of his or her tongue on the drop of wax sit-
uated on the posterior border of the maxillary base, according to
the Schuyler technique.11
In the meantime,the practitioner’s left hand should be invert-
ed,the thumb and index finger introduced between the maxillary
rim and the mandibular record base posteriorly to hold the bases
steady and against the ridges.The patient should be asked to close
gently while his or her chin is held between the thumb and the
index finger ofthe practitioner’s right hand (Figure 2).The purpose
is to gently guide the closure movement.During closure,the fingers
of the left hand should slide out progressively12to clear the way for
the closing mandible, which should close until the height that is
judged correct for the vertical dimension is reached. The closing
movement ofthe mandible should be stopped,and the height ofthe
face should be checked with a ruler or a caliper. The mandibular
wax mini-rim should be rubbed with the thumb of the right hand
to adapt it against the maxillary rim. The patient should then be
asked to further close his or her mandible in case it falls short ofthe
calculated dimension;otherwise,the softened wax is rearranged to
meet the calculated height.
Next,the mandibular base should be retrieved from the mouth
and the excess wax trimmed,guided by the imprint of the maxil-
lary rim on the mandibular mini-rim. The mandibular mini-rim,
which should then be chilled in cold water, serves to hold the
mandible at the desired vertical height.
With the record bases back in the mouth in closing position,
three vertical lines should be scratched,one in the midline and two
laterally, on the maxillary and the mandibular rims. This enables
the practitioner to control and guide the centric relation recording
later on (Figure 3). Two non-parallel V-shaped notches should be
cut on the maxillary rim in the molar region in preparation for the
index with the recording material.
While the maxillary rim is in the mouth,fast-setting impres-
sion plaster (Xanthano, Heraeus-Kulzer, Dormagen, Germany) should be
mixed to a creamy blend and spread,slightly in excess occlusally,on
Figure 1. Wax wafer in anterior region of mandibular base.
Figure 2. Closure of mandible stopped at desired vertical height.
Figure 3. Occlusal rims in mouth, with vertical control lines.