Book Review: Next Generation Biomaterials for Bone and Periodontal Regeneration

By David F. Boden, D.D.S., M.S.

This book is a comprehensive review of current techniques and efforts for the future of regenerative surgical procedures.  It is a series of 23 short review articles by international researchers.  While directed primarily to periodontists and oral surgeons due to the depth of background information needed to fully appreciate the implications of the future techniques presented, it is also fascinating reading for all doctors to see where the profession is heading.

Topics covered include all types of bone grafts; guided tissue and guided bone membranes; bone adhesives; osseo-conductive and osseo-inductive protein matrices; several bone morphogenic proteins; existing and future enamel matrix derivatives; hyaluronic acid; and future gene therapy for growth factors.

The most intriguing chapters review the newer regenerative techniques.  The articles alternate between the hard biochemical science and clinical research and applications.  Each article is highly referenced.  The reader will notice a wide variety of references from many journals most clinicians would miss which makes this publication a very good start for literature reviews and background material for new papers.  There are caveats, however.  While the main author/editor of this book is undoubtedly prolific and at the forefront of research in regenerative techniques, the citations are fairly heavy with his own publications.  Furthermore, disclosures of financial conflicts of interest by the authors/editors, if any, were not presented as they are when new materials are published in peer reviewed journals.  It must be assumed those disclosures were noted in the original source publications that are summarized in this book.

The reviews are exhaustive and very revealing.  Please note that this is not a “how to” surgical manual.  Research about individual regenerative materials, as well as combination of materials, is meticulously presented and analyzed in a very orderly way.  Tables and charts are nicely presented to compare findings.  Quick reference for the reader as to what materials work and do not work can be made at the conclusion of each article, with a final chapter presenting clinical recommendations and guidelines for selecting the best combination of biomaterials for specific cases.

Publications of this type are critical to bring practicing clinicians who may not have access to all publications up to date so application of new proven techniques and materials can be more rapidly incorporated into practice, ultimately to help our patients gain better oral health.

Teens & Nicotine: The Influence of Flavoring on Teen Behaviors & Addiction

Carol A. Jahn, RDH, MS |  | 708-899-1886

In the fall of 2015, I attended a conference where the general session speaker was a tobacco cessation specialist.  At the time, I was a neutral on the subject.  I didn’t think – wow, I can’t wait to hear this, but neither did I think it wouldn’t be worth my time.  I have a sense that a lot of my colleagues felt similarly.  However, when the speaker made his opening statement, the room grew quiet, and he had our undivided attention.

What did he say that was so compelling?  He opened with:

Tobacco is the only legal consumer product that kills at least 1 out of 2 of its regular users when used as intended by the manufacturer.”1

During my clinical dental hygiene years, I was no stranger to the detriments of tobacco on oral and general health. I had worked in a periodontal office in the 1980’s where every day six or seven of my eight patients either used or had used cigarettes.  I had also been in a general practice during the early 1990’s and had shockingly witnessed the resurgence of cigarettes among teens and young adults.  But by 2015, like many, I had naively thought, we were on the upside of the battle with cigarettes.

Little did I know how I wrong I was. Little did I know that earlier in 2015, a new type of e-cigarette called JUUL had been introduced.  Little did any of us know the enormous impact and influence it would have among youth.

In 2016, JUUL garnered about 5% of all e-cigarette sales.  By the end of 2017, it was the leading e-cigarette brand, and at its peak in late 2018-2019, it had more than 70% of the market.  The JUUL brand’s popularity with youth helped drive a 135% surge in youth vaping between 2017 (11.7%) and 2019 (27.5%).2

Three things helped drive its popularity with youth.  It has a sleek compact design resembling a USB device making it easy to use discreetly and conceal at school and home.  The nicotine formulation in JUUL is made from nicotine salts instead of free-base nicotine.  This does two things.  It provides the user with a better experience and more nicotine.  One JUUL pod has the nicotine equivalent of a pack of cigarettes.  When introduced, JUUL pods came in numerous different, youth appealing flavors.  Flavored nicotine is preferred by over 80% of youth vapers.2

Today’s JUUL popularity has declined to about 40%.2  The 2021 Monitoring the Future Study found that student vaping rates are declining nearly showing 1 in 5 high school students vaped in the past month.   However, vaping is still the predominate method for nicotine consumption in youth.  Rates of smoking for traditional cigarettes fell to an all-time low of 4.1% among high school seniors.3

What are the effects of vaping products on oral and general health?  While the long-term effects of vaping are unknown, nicotine is highly addictive.  Research has shown that teens who vape are six times more likely to begin using traditional cigarettes.4  Nicotine can harm the developing brain including affecting the parts of the brain that impact attention, learning, mood, and impulse control.5

E-cigarettes have been promoted as means for tobacco cessation. In the United Kingdom (UK), vaping is considered an effective tool to help people stop smoking. The European Union regulates vaping differently from the US; for example, JUUL vaping pods have half as much nicotine in the UK as the US.  Importantly, far fewer teens vape in the UK with 1.6% reporting weekly use.6

Smoking rates are down not just among teens but adults as well.  Yet the emergence of new products like e-cigarettes mean this is a subject we cannot take for granted.  A recent study conducted with Southern California teens found that while vaping is still the most popular nicotine product, flavored oral nicotine products such as gums, lozenges, and gummies are ranked second.7  As dental professionals, we need to be aware of the products beyond cigarettes and be able to talk knowledgeably about them with patients.


  1. Els C. Interrupting the disease of tobacco addiction. J Dent Hyg, 2015, 89(Suppl 1.): 16-19
  2. Campaign for Tobacco Free Kids: JUUL and Youth: Rising e-cigarette popularity.  Accessed Aug 9, 2022.  Available at:
  3. Campaign for Tobacco Free Kids: 2021 Monitoring the future study shows youth e-cigarette use remains a serious problem.  Accessed on Aug 9, 2022.  Available at:
  4. Barrington-Trimis JL, UrmanR, Berhane K, Unger J et a.  E-cigarettes and future cigarette use. Pediatrics, 2016; 138(!):e20160379
  5. Centers for Disease Control and Prevention.  Quick facts on the risks of e-cigarettes for kids, teens, and young adults.  Accessed on Aug 9, 2022.  Available at:
  6. The US and UK see vaping very differently.  Here’s why.  CNN Health.  Access on Aug 9, 2022.  Available at:
  7. Harlow AF, Vogel EA, Tackett AP, Cho J et al. Adolescent use of flavored non-tobacco oral nicotine products.  Pediatrics 2022; Aug 8; e2022056586

About the author: Carol Jahn, RDH, MS is the Director of Professional Relations & Education for Water Pik, Inc. She has been providing continuing education courses for more than 25 years. Carol is an author, speaker, and industry leader and has published numerous articles and contributed to several textbooks.

Responding to the Mental Health Needs of Dentists

By Alan Budd, DMD

When first-year students at Tufts University School of Dental Medicine feel overwhelmed, they might unwind with a yoga class or meditation session. Dr. Christina DiBona Pastan, an endodontist and director of Mind-Body Wellness at Tufts, has developed a course on wellness that is required of all students. The curriculum focuses on lowering stress to improve students’ overall wellbeing, decreasing burnout and increasing resilience.

Support for a dentist’s health and wellness has come a long way. The first programs formed in the late 1970s consisted of dentists in recovery; think AA for dentists. These groups were a lifeline for dental professionals with substance use. Due to stigma, they were also a wellkept secret. To an extent, they still are. According to the 2021 American Dental Association (ADA) Wellbeing Survey, only 46% of dentists know that their state association has a wellbeing program.1 The notion that patient care and self-care can coexist continues to escape many of our colleagues.

Front-line worker health suffered terribly during the pandemic. Dentists have had their share of challenges. The percentage of dentists diagnosed with anxiety more than tripled in 2021 compared to 2003, according to the ADA’s 2021 Dentist Health and Wellbeing Survey Report.2

Even before the COVID-19 pandemic, health workers were experiencing alarming levels of burnout – broadly defined as a state of emotional exhaustion, depersonalization and a low sense of personal accomplishment at work. Burnout can also be associated with mental health challenges such as anxiety and depression.3

Anxiety and depression aren’t the only mental health issues. Many are also experiencing notably higher rates of insomnia, anxiety, stress, fatigue, burnout, depression, somatization, obsessive-compulsive symptoms and post-traumatic stress disorder.4 More than 50% of public health workers reported symptoms of at least one mental health condition, such as anxiety, depression or increased levels of post-traumatic stress disorder (PTSD).5

There has been a notable increase in substance use.6,7,8,9 Experts say misuse of opioids and stimulants is also on the rise.10 In response to a CAGE-AID questionnaire, 12% of dentists agreed with one statement, and 11% agreed with two or more. A “yes” answer to even one item indicates a possible substance use disorder and a need for further testing.11

The isolation of private solo practice, access to controlled substances, denial of a problem because of higher education, and enabling coworkers may be partly to blame for difficulty identifying ill or impaired dentists. Direct observation is vital to detecting diversion and may be the only way to identify an impaired colleague.12

These findings and some high-profile suicides among leaders of organized dentistry have spurred the ADA and ADA Council on Dental Practice to take action on supporting the wellness of dentists:

  • The House passed Res. 95H-2021, Prioritizing the Mental Health of Dentists, which stipulated that the ADA, in conjunction with mental health consultants, analyze the availability of resources to support the mental health of dentists.13 The ADA is an active contributor to the National Academy of Medicine’s Action Collaborative on Clinician Wellbeing and Resilience.14 This program was launched in 2017 to improve baseline understanding of challenges to clinician wellbeing, raise the visibility of clinician stress and burnout and elevate evidence-based, multidisciplinary solutions.15 “The stressors of the dental profession begin with dental students in their first year of dental school. At Tufts, we teach our students practical applications of mindbody practices in the academic and clinical settings and we are seeing the benefits in them personally and professionally. Stress management resilience building skills are essential for overall wellbeing and also contribute to developing grounded professionals enabled to deliver mindful and compassionate patient care,” according to Christina DiBona Pastan, DMD, Director of Mind-Body Wellness Office of Student Services.
  • The ADA is training the first cohort of dental professionals called to serve on its new initiative, the Wellness Ambassador Program, in which volunteers will work to ensure that peer dentists struggling with health obstacles are aware of support services. Chief among the ambassadors’ messaging is that members and nonmembers can download the ADA Dentist Well Being Program Directory at for free through the ADA store to find their state program director’s contact information, with all calls or emails kept strictly confidential.16
  • The National Council of Dentist Health Programs is a national member organization of state dentist wellness programs (DHP) established in 2022. State member programs provide a confidential, therapeutic alternative to discipline and have the support of organized dentistry in their state, often through legislation, exceptions to mandated reporting, or other safe haven provisions. In addition to working with participants, DHPs provide education, outreach and advocacy to their communities to support dentist health and wellbeing.

If you or a dental colleague are experiencing substance use or other mental health crises, we encourage you to contact the ADA Dentist Wellbeing Advisory Committee. All calls are confidential.

References Available Upon Request

How to Stay on Track with Your Professional Development Plan

By Karen Weeks

A professional development plan is key to a successful career in the dental field. By assessing your skills and knowledge, setting goals and getting the necessary training or continuing education, you can boost your career and achieve your long-term goals. The Florida Dental Association invites you to keep reading to learn how to create a professional development plan to help you stay on track.

Create a Standout Resume: Robert Half points out that one of the most critical parts of any professional development plan is creating a stellar resume. Your resume is often the first impression you make on potential employers, so it’s important to take the time to craft a document that accurately reflects your skills and experiences. An online resume maker is the easiest way to create a standout resume. 

Gauge Your Current Skills and Knowledge: Before you can set goals, CareerAddict notes that you need to assess your current skills and knowledge. This will help you identify areas where you need improvement. There are several ways to evaluate your skills and knowledge. You can take an online quiz or assessment, participate in a focus group or reflect on your past experiences. Once you have a good understanding of your strengths and weaknesses, you can begin setting goals.

Be Prepared to Adjust to Varying Roles: As you progress in your dental career, your professional roles will inevitably change. It’s important to adjust your professional development plan accordingly. For example, if you are promoted from an entry-level position to a management role, you will need to update your plan to reflect your new responsibilities. As your roles change, so should your goals. Be sure to regularly review and update your professional development plan always to reflect your current situation.

Assess Whether You Need Additional Training or Education: Once you have assessed your skills and knowledge and set goals, it’s time to get the necessary training or continuing education. There are many ways to do this, such as taking classes at a local community college or university or attending workshops or seminars offered by professional organizations. Many employers also provide training programs for employees who wish to further their careers within the company. Be sure to take advantage of these opportunities when they arise.

Keep Documentation of Your Development: It’s essential to document your professional development along the way so that you can track your progress and show potential employers what you have accomplished. Keep copies of certificates or transcripts from courses or training programs you have completed. You can also keep a portfolio of projects you have worked on or articles you have written. Whatever method you choose, be sure to keep meticulous records so that you can easily access them when needed.

What’s more, instead of using many files, you can keep all related documents in one file, which will cut time on having to find a document. To delete PDF pages, you can use an online PDF page remover to quickly delete pages and then save your file when you’re done. 

Prepare to Start Your Own Business: If starting your own business is one of your ultimate goals, it’s important to understand what it takes to make that dream a reality. In addition to having a detailed business plan, you will need capital investment, market research and a solid understanding of small business accounting. You must also obtain the necessary licenses and permits before starting operations. 

Give careful consideration to how you structure your business. An limited liability company (LLC) provides extra protection, flexibility and tax benefits. You can affordably file your LLC by working with a formation service but read reviews to help you decide which service is best for you. While starting a business is no small feat, it can be immensely rewarding both professionally and personally.

A well-thought-out professional development plan is essential for anyone looking to boost their career in the dental field. By taking the time to assess your skills and knowledge, set goals, get the necessary training and learn how to start a business, you can put yourself on the path to success. Use the tips outlined above to create a professional development plan to help you stay on track and achieve your career goals.