When a patient has periodontitis, they suffer from a destructive inflammatory infection that significantly impacts their oral health and damages their periodontal structures. Understanding how occlusion impacts or worsens this damage is key to helping these patients prevent unnecessary trauma.

Periodontitis and Occlusal Trauma

Even before the 1960s, there was research linking occlusal trauma and progression of periodontal disease. More recent research has found that this link isn’t as strong as once thought. Still, a relationship has been identified between the extent of damage and whether the patient has an occlusal interference.

One crucial aspect of periodontitis is that it is unique to every patient. This means we have to be careful not to apply a blanket approach to all patients or rely too heavily on past data that may not help us treat our current patient. Their individual susceptibility to periodontitis must be assessed based on their distinct risk factors.

The Relationship Between Occlusion and The Periodontium

For each tooth, occlusal experience matters and may be one of the reasons that loss of attachment worsens. A 2001 study by Harrel and Nunn found that there was a correlation between amount of periodontal damage and existence of occlusal interference. Perhaps more interesting, they also found that changing the occlusion had a positive impact on the periodontal issue.

Even in light of this research, the relationship between occlusion and periodontium is hotly contested. Regardless of one’s opinion on this matter, there’s no denying that the periodontium is effected by occlusal force. When there is no occlusal loading, there may be over-eruption or drifting of the tooth. On the other hand, when the force is appropriate, the periodontium is healthy and stable.

We must remember that there is a spectrum of susceptibility to periodontitis. For those who are very susceptible and also have teeth experiencing occlusal trauma, the latter only serves to worsen the situation.

When you come to Key Biscayne and Miami, you should treat yourself in as many ways as you can. From the moment your plane sets down, it’s time to embrace the Miami spirit of indulgence and fun. The best way to do this is by shopping ’til you drop.

One of the most common questions we hear all the time is: Where is the best shopping in Miami? It’s not an easy question to answer. Miami has the kind of fashion, jewelry, and beauty scenes that celebrities are known to wander.

Still, we’ve managed to narrow down the list to a few fun locales. These excursions may lighten your wallet or may have your jaw dropping at the decadence. Either way, you won’t be bored!

Luxurious and Indulgent Shopping the Miami Way

1. Bal Harbour Shops

This beautiful open-air shopping mall in Miami Beach requires mental preparation for the shopaholic. Designer boutiques are the norm at Bal Harbour, where the air oozes exclusivity. Wander this super high end, exquisite mall and settle in for a long meal at one of the restuarants. It’s truly an unmissable experience.

2. Miami Design District

Fashion fiends will swoon over this trendy shopping location. It’s a hotspot for flagship stores from top designers and becomes an even more enriching visit when you witness the thought provoking art and sculptures around the area.

3. Coconut Grove Boutiques

Coconut Grove is a region of Miami known for its quirky boutiques. Here, you definitely won’t be overwhelmed by pricey displays or high fashion. It’s a much more approachable shopping experience. Peruse the central business district for an hour or two of casual fun.

All in all, Miami is a prime destination for shopping, which makes a great low-key activity. How do you indulge yourself on trips? We’d love to hear from you!

There are so many different processes, techniques, and skills that go into a functional dental practice that it can be hard to keep track of them all. Seemingly inconsequential things like referrals can get the better of us if we don’t have a solid system in place.

Patient Friendly Referrals

The best specialist referrals involve open communication and provide patients with a sense of care and consideration. Patients prefer to be given a tangible referral tool, such as the specialist’s brochure, along with your confident assertions of their quality. This gives them something solid to associate their trust with and provides further familiarity.

Validation of your referral comes in other ways as well. Patients will want you to provide the introductory information that you might assume the specialist will want. It’s important to remember that they won’t automatically feel comfortable putting their health in someone else’s hands.

You might consider asking the patient if they would like your office to call the specialist to establish the referral and set up their first appointment. This strengthens their sense that you are actively involved in the referral and have a strong relationship with the other office and team. It’s proof of your commitment to their health.

A big no-no is not discussing the patient’s condition with the specialist before their appointment. It will become very obvious to the patient if you haven’t done your due diligence in helping the specialist understand their needs. They will feel stranded and ignored, and often are uncertain that the specialist will communicate back with you after their visit.

Finally, make sure you have an arrangement with the specialist ahead of time that they will check in with you after the treatment. Then, once the patient returns to your practice, you can share with them all you learned from the specialist since they were there.

How do you ease patient concerns during the referral process? Leave a comment below!

Everyone who heads to Miami expects to try world-class cuisine from all over Latin America. But did you know Miami is also a fantastic place to sample delightful European dishes? In particular, the area boasts a wealth of French restaurants you won’t want to pass up.

If you’re unfamiliar with French food, it’s usually rich, flavorful, unique, and satisfying. Think coq au vin, bouillabaisse, hearty soups, delicate seafood, croissants and crepes. Here are our top four favorite spots:

4 French Must-Try Restaurants in Miami & Key Biscayne

1. La Boulangerie 

For giant, flaky, out-of-this-world croissants, you have to visit La Boulangerie on Key Biscayne. This is hands-down one of the best breakfasts in the area. The service is fast, the fresh orange juice is to die for, and it’s extremely convenient for Pankey participants. Make sure to get there as early as possible before they run out of the most coveted treats!

2. Otentic Fresh Food Restaurant

Appreciate a traditional French meal in an atmosphere that screams Miami Beach. This quaint and cozy dining experience serves up the classics: foie gras, escargots, charcuterie, savory crepes, fresh mussels in white wine and cream, quiche lorraine and more.

3. A La Folie Cafe

Refined without breaking the bank, A La Folie is known for its extremely yummy crepes. Relax over a meal that will transport you to France in the best way possible. Sweet and savory are right at your fingertips.

4. Brasserie Central

This Parisian-style brasserie in Coral Gables is perfect for sipping cafe au lait and diving into a luxurious dessert. Try our favorites: the Belgian waffle with chantilly and chocolate or the crisp apple tart.

Please run, do not walk to each of these fantastic purveyors of all things French. If you try one out, let us know what you thought! Miami never ceases to amaze us with its international flavor.

Maintaining the gingival margin during a restoration is one of the more challenging aspects of restorative care. Part of why this can be so difficult is that the gingival crevice is not always well understood.

The goal with a restoration should be to limit the possibility of inflammation or gingivitis post-treatment. This can only be accomplished if the intracrevicular margins (meaning those placed within and limited to the gingival crevice) are properly created.

There are multiple techniques needed for this goal, but one critical piece is how the tooth is prepared.

Successful Tooth Preparation Guidelines

There are multiple components of an ideal tooth preparation, including distinct margins and sufficient tooth reduction. If you have to extend the material you are using into the gingival crevice, then you must ensure the intracrevicular tooth reduction is large enough to account for the cosmetic material that will inevitably recess into the tooth’s normal shape.

One thing that absolutely must be avoided is forcing cosmetic material out into the tissue. This can occur as a result of under reducing the cervical aspect of the tooth. The negative effects of this problem are plaque growth, decreasing the patient’s ability to adequately cleanse the area, and a crevice that appears flabby and retractable. You’ll see these problems happening because as the cervical bulge protrudes, it distends the crevicular epithelium and connective tissue.

Sometimes, you may put plenty of care and precision into your effort and still find that the tissue is injured during your tooth preparation. To avoid this, you can consistently follow these simple guidelines:

1. Don’t overextend the rotary instrumentation circumferentially.

2. Avoid permanently damaging surrounding tissue during retraction or while making impressions.

3. Create polished and excellently contoured margins, as well as a great fit, for the interim restoration.

4. Prevent retention of temporary cement in the gingival crevice.

5. Sustain control of intracrevicular plaque.

Follow these guidelines and you’ll be on your way to long-lasting results.

How do you go about enacting successful tooth preparation in your restorations? We’d love to hear from you!

Dr. LD Pankey was born and reared in Southern Illinois over five miles of countryside. His father had a grocery store and a farm, but he didn’t venture into the larger world until he was ten years old. When he was about 12, he fell in love with dentistry while climbing the steps to a dental office for the first time. He knew then it was what he wanted to do.

Dr. Pankey moved to Indiana halfway through high school to get an accredited high school education. Then he went to the University of Louisville and graduated at 22 in 1924. That was the beginning of his career.

His wife was a dentist’s daughter who he met at a board meeting. They married in 1933. He has three daughters and a son, who went on to be an orthodontist. But without a crucial move early in his career, everything might have been different for Dr. Pankey.

Courage in the Face of Complacency: Why Dr. Pankey Moved to Florida

Dr. Pankey’s first practice was in Newcastle, Kentucky. After graduating, his advisor in dental school told him to take on this practice in Kentucky from a dentist who was moving to Florida, as he knew Dr. Pankey was young, broke, and $3300 in debt (at the time, this seemed like a lot more money).

He suggested Dr. Pankey gain some maturity and security in a practice that was already built up before moving on to bigger and better things. Dr. Pankey had nine patients the first day and fourteen the second, a trend which continued for many months. He paid off his debt, was happy, and bought a new car.

At the time, he wrote a letter to his mother about how well he was doing. She responded saying she was glad for him, but that she hoped he wasn’t providing poor dental care. She had recently had dentures placed and hadn’t felt good since.

This formative interaction made him very unhappy because he was in fact practicing the kind of dentistry his mother had experienced. He also felt he had become too comfortable. In 1925, he left for Florida and promised to save teeth not remove them. This was the beginning of the development of his philosophy of practice and his journey of continuous learning, a concept he taught other dentists until the end of his life.

The rest is Pankey history!

The question of what makes something ‘aesthetic’ or pleasing to the eye is one that often plagues dentists. We are so concerned with our patients’ perceptions of beauty that it is always on our mind.

The sense of aesthetics is an innate quality that we all carry. This sensibility is intertwined with our own internal creativity and curiosity, as well as our desire to create. Many people conflate a particular affinity for aesthetics with a lesser ability in other more technical areas, but in reality these are not mutually exclusive.

As dentists, we balance the technical and the aesthetic every single day. It can be challenging to handle the needs of both these areas in concert.

A Pankey Take on Aesthetics

Dr. Pankey had a particularly eloquent way of describing aesthetics. He clearly had a great appreciation of the world. This is why he combined his appreciation for aesthetics with the needs of dentistry, which resulted in multiple insights about the complexities of aesthetic dentistry.

Dr. Pankey’s aim was to learn the ins and outs of dental aesthetics to maximize quality of patient care. He had a vision of organizing all of the information he had acquired and making it available to more dentists.

The S Curve

An important tenant of dental aesthetics is the ‘S’ shaped curve that visually stimulates a sense of beauty. This has to do with the way it moves the eye and creates a flowing movement. The curve is a common aesthetic aspect of teeth and tissue, especially in the tips of every papilla to the zenith point.

We see the S shape as a result of the emergence profile or the angle of the entrant line of each tooth. Contour also plays a role in this specific part of the smile’s appearance. All in all, it’s important to pay attention to this aesthetic nuance in your work.

What do you think is the most important consideration for aesthetics in dentistry? 

Miami is a sprawling tropical metropolis dotted with palm trees and bright splashes of color. It has many different iconic neighborhoods such as Miami Beach and Little Havana.

That’s why it can be difficult to decide which face of Miami you want to see. European and art deco? Latin American and vibrant? Upscale and polished?

Here’s our guide to exploring the beautiful and always entertaining Miami:

Which Part of Miami Should You Visit?

1. Calle Ocho

This memorable street in Little Havana is known for good Cuban food and its unique atmosphere. The area is Cuban through and through, which will give you a taste of the culture without ever having to leave the country. While you’re in the area, check out Versailles restaurant for authentic Cuban cuisine.

2. Wynwood Art District

This is the hipster paradise of Miami, where you’ll find a multitude of art galleries and craft beer establishments. Visit Wynwood to soak in eclectic street art or grab a beer at a brewery like Concrete Beach.

3. Lincoln Road

Upscale Miami lies on a stretch of road referred to as ‘Lincoln’ that features all of the coffee shops and luxury stores you could ever want. It’ll be difficult to keep yourself from splurging in one of the boutiques.

4. Miami Beach

This is the area that most people associate with Miami. Its appearance has that distinct Miami look, complete with art deco buildings that are a delight to see.

5. South Beach

South Beach is retro Miami at its finest. It can be a bit touristy, but it does have fabulous restaurants and a breezy, relaxed sensibility. This is the place where you want to get a satisfying brunch before settling back at the beach.

What do you want to visit the next time you come to Pankey? Let us know in the comments! 

One of the keys to delivering meaningful patient care is upholding the power of relationships in all aspects of your work life. For example, clear communication in the patient referrals process can either make a patient feel doubly supported or leave them feeling insignificant.

So how do you foster good relationships with the specialists you refer to that improve patient trust?

Patient Referrals: Communication, Relationships, and Trust

It’s not uncommon for a dentist to refer their patient to a specialist, only for the patient to realize the specialist hasn’t been told anything about their unique case. This clumsy pass between health care professionals starts the patient off with a heightened level of distrust.

Then, the situation can be made even worse if what the patient learns from the specialist is very different from what their dentist told them. They can become frustrated by the inconsistency or angry that they are being given conflicting information.

The solution to this problem is as simple as it is difficult to enact consistently. Patients will develop increased trust with their general dentists if they are led to believe the general dentist is skilled at referring them to specialists.

Additionally, they should feel that their case is handled with great care in the transition period. Their general dentist should make the process smooth for everyone involved and communicate expectations with the specialist.

Patient trust is everything. They will not follow you on the path to more advanced or complex treatment, or even come to think of you as their long-term dentist, if they feel the relationship is built on shaky ground. Who you refer to and how you do it can either strengthen that relationship or do the exact opposite.

More than anything, you must show the patient you are very familiar with the specialist and advise the specialist about the patient in turn. The specialist’s office should then be able to affirm your relationship with the patient by providing complementary care and information.

When you and the specialists you refer to provide conflicting treatment plans or explanations, doubt inevitably creeps in.

How do you communicate effectively in the referrals process?