Doctors New York:
Excellence is SmileMD Accountable Care Program
Editor-in-Chief, Natalie S. Huffman, CAO
Wednesday, June 22, 2011 - 07:01 PM
Physicians, Dentists and Associates
In cities all across America, www.smilemd.com and www.dentalvisits.com are listing
high on the first page(s) of Google; this permits doctors like you to instantly
book unused appointments on a daily basis or publicly display available appointments
to new patients for emergency visits. We'd like to list your medical or dental office(s)
and associate(s) there. We’ve introduced Google “AdWords” advertising to the Top
Cities nationwide and if you don’t see your city listed in the search results, please
let us know. Eventually, it will show up. Actually we’re offering you spot advertising.
It’s going to make the difference! Do this Google search: "Dentist or Doctor and
(enter your name and your city)". We’ve got it NOW and your office(s) can be listed
Independent physicians and dentists are back where they belong—in control of their
practices and leading American health care by supporting SmileMD and Dentalvisits
commitment to AFL-CIO union affiliation. These organizations contract with independent
physicians and dentists, and provide services to managed care organizations on a
negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis.
Doctors have had it with the way that they and their patients have been treated
by the health care industry.
We've identified you as a top local doctor. We only want the most legitimate doctors
on our site and to us, that's YOU! Take a look around, other companies are charging
tens of thousands of dollars to do what we have already accomplished. For doctors
who want more new patients, we've done this all around the country and now we want
you to fill the local listing in your area or zip code. Our domain provides expertise
targeted at brain function, weight reduction, smoking cessation, and life extension.
We also have a comprehensive program available with video, print and web based components.
We’re featuring this exclusive web listing offering(s) solely for introduction and
assistance to help you make the transition to partnering with SmileMD Inc.
Doctors may increase volume from 600 patients to more than 5,500 with our EHR group
practice and spend more time with each patient. All patients get a yearly exam and
extensive testing to provide a baseline for evaluating their conditions. Doctors
spend more than an hour with each patient to do thorough examinations. SmileMD is
making an impact on the care of patients, with more time to spend with each patient;
doctors can focus on preventative medicine and follow up on the care of each person.
Medical Home Model
SmileMD practices are structured to resemble a medical home model in which the personal
physician leads a team of individuals at the practice level who collectively take
responsibility for ongoing patient care. According to the American Medical Association,
this method of delivering care differs from traditional fee for service in that
payments are based on the ability to demonstrate evidence-based protocols, self-management
education, and care coordination with specialists and other facilities.
Excellence and Accountable Care
SmileMD has brought together leading experts in the fields of wellness and preventative
medicine to formulate an individualized plan for each patient and implement program
goals of Excellence and Accountable Care. Each treatment plan includes short- and
long-term goals. Nurse practitioners assist in patient care, while certified nutritional
specialists and registered dietitians serve as “health coaches” overseeing Excellence
in the Accountable Care program. Consulting dietitians work on the development of
nutritional practices that emphasize the supportive and therapeutic roles of specific
dietary plans and supplemental protocols. Clinical social workers practice the goals
of enhancement and the maintenance of physical, psychological (mental and emotional),
social and spiritual well-being and the functioning of individuals, families, small
groups and communities.
After a plan has been developed for patients, dietitians take over to implement
directives related to nutrition and exercise. To encourage patients to use these
resources, all wellness visits are provided at no cost with unlimited access to
dietary services. Depending on the patient’s health condition, a specific program
may consist of nutritional counseling to reduce HgBA1C, glucose, cholesterol, triglycerides,
and LDL. Exercise counseling is aimed at reducing body weight, blood pressure, and
Ecological Medication Successions
Medical home models resembling SmileMD’s are decreasing both morbidity and hospital
emergency visits by more than 50 percent. SmileMD practices see more people with
multiple conditions, which resulted in poor outcomes prior because of poor compliance.
Our statistics show these practices conditioned patients to ecological medication
successions like, Zocor for high cholesterol, Paxil for anxiety, Zenikal for uncontrolled
weight gain, Lomotil for diarrhea, Scopederm TS for motion sickness, Ritalin for
short attention span, Relenza for uneasy stomach, Zyrtec for hay fever and Aspirin
for headaches. By providing better access to doctors, nurses, other health care
professionals, and medical extenders who regularly follow up with good healthy diets
and take action on exercise recommendations for each patient, outcomes are proving
Personalized Patient Care
SmileMD is the referral source. Patients follow up with us. If a patient doesn’t
show up for a scheduled visit, doctors follow-up. With SmileMD tracking each patient’s
progress, we have a complete circle with no breaks in the loop, as follow-up is
critical. There is no follow up in most traditional practices to close this loop.
Patients are embracing the concept. They like SmileMD, and we are here 24/7, whenever
they need us. Patients enjoy having customized care available in one place. Patients
who probably would never go to another health professional, upon referral are coming
back to us for their health care needs.
Home Care Services
SmileMD staff also provides personalized care that patients can’t get most other
places. Nurse practitioners make house calls to elderly patients who can’t go to
the office. Nutritionists and social workers also do in-home assessments when needed.
Doctors do their own hospital rounds and give patients their telephone numbers so
they can call them in case of a problem. We’ve cut the number of Emergency Room
visits because often we can give monitored patients telemedicine remedies, over
the phone, which will solve their problem. Not only does that prevent the patient
from sitting in the ER for hours, it provides tremendous savings to third-party
Major Healthcare Services
Patients can participate in various clinical forums offered at each of our entertainment
cafés, including cooking classes, yoga seminars, and programs on healthy eating.
Such information can help them succeed in reaching their health goals. Patients
have interactive online conference access 24/7 on www.dentalvisits.com and www.smilemd.com
Again, it all goes back to proactive medical and dental care, more patient time,
and instead of making referrals; patients are treated in our offices. At the end
of the day, we make the difference, what we do better is deliver major healthcare
services, cancer surgery, cardiac procedures, cataract surgery, hip and knee replacements,
as well as MRI and CT exams.
DR. JUDY JOHNSON is a member of The New York Academy of Cosmetic Dentistry. Here
she's questioning a top New York cosmetic restorative dentist, Dr. Samuel Waknine
about the importance and advantages of using optimum materials in modern restorative
dentistry; and about how TODAY'S RESTORATIVES RIVALS ACTUAL ENAMEL AND ARE ABLE
TO SUSTAIN WEAR THAT IS AS LOW AS THREE MICROMETERS PER YEAR. Dr. Waknine is President
of DRM Research Labs, which is mostly involved in research and development. He lectures
at the academic and private sector level, providing either operative or technological
instruction to clinicians and technologists all over the world.
DR. JUDY JOHNSON (QUESTION): Do you think that markets in the United States, or Central
and Eastern Europe are ready for products with high aesthetic quality and state
SAMUEL WAKNINE DDS (ANSWER): I think so! I've had a vast amount of experience lecturing
worldwide and interacting both in the industrial sector as well as in the clinical
and academic sector with many technologists, professors and clinicians whether it
is in Lithuania, the Czech Republic, Poland or Russia. Indeed such materials are
becoming more and more popular in those venues due to the fact that firstly, they
are easier to use, secondly, they require less machinery and equipment in the laboratory
and thirdly, chair-side time is significantly reduced.
The main disadvantages to this more sophisticated material is that it requires a
dry field of operation during the momentary placement procedure, however, I think
the advantages outweigh the disadvantages due to the fact that one has a material
that is functional, aesthetic, matches tooth color, that is serviceable and is biocompatible,
healthier overall compared to the traditional silver amalgam fillings and the standard
crown and bridge alloys; nickel chrome, chrome-cobalt and silver-palladium products.
With traditional materials it takes two to three days and an innumerable amount
of equipment, instruments and adjunct materials before a crown or a bridge is fabricated,
whereas with our materials one is able to fabricate a rather vast or large restoration
in less than one hour. So from a time, effort and equipment perspective, this is
the preferred methodology for the laboratory.
DR. JUDY JOHNSON (QUESTION): Are there any other advantages of modern restorative
SAMUEL WAKNINE DDS (ANSWER): If we looked at a dental restoration in a chronological
manner from infancy to adulthood, from pediatric dentistry to geriatric dentistry,
we start out with a little tiny one-surface cavity, that escalates to a two-surface
filling, then possibly leaks and has to be repaired and becomes a pin-retented three
- or four-surface silver amalgam filling undermining the surrounding enamel, and
then onward to a crown (usually poorly adapted or sealed), followed by endodontic
treatment and a post/core build-up encapsulated by a crown prosthesis and possibly
an extraction, even a bridge, usually non precious alloy (porcelain fused to metal),
subsequent alveolar bone resorption and then possibly a removable prosthesis; partial
or denture followed by ridge augmentation and possibly an implant. Because silver
amalgams are very limited they usually have to be repaired somewhere down the line.
By the time they have to be repaired, the carious lesion site usually has progressed
so vastly that it invariably turns into a three-quarter crown or a full crown. On
occasions, one even has to resort to crown and bridgework.
The approach with the new modern poly-ceram restorative materials is that if one
can achieve a very good seal at a tooth restorative interface, which is really the
hub or area of concentration of the technology, and then one can reduce the possibility
of having to remake the restoration and ensue this very tedious and complicated
voyage. This is not the case with the advanced restorative materials. If there is
a failure it tends to be rather minor and require very quick patch-up and repair
at the adhesive interface and so the incidences of secondary caries, remakes or
repairs is significantly lower in potential expenditure and tooth loss. Which is
a massive advantage whether you are in Prague, London or New York City?
DR. JUDY JOHNSON (QUESTION): What about the issue of durability?
SAMUEL WAKNINE DDS (ANSWER): That is a very good point. There is a propensity to
judge today's restoratives of the poly-ceram category by 'bunching them' with those
of 40 years ago, particularly among dentists who were accustomed to those products
then. However, composites or bonding materials from 40 years ago are a far cry from
what is available today. Since then, we have gone through about seven generations
of products and probably tens of thousands of research projects documented in the
form of manuscripts and patents, so there has been a good deal of innovative progression
in this field of technology.
Consequently, today there are several products that are very reliable. From the
perspective of wear resistance, today's restoratives are able to sustain wear that
is as low as three micrometers per year? Which rivals actual enamel? This compares
with 40 years ago when it was 150 micrometers per year. According to statistics
from pooled clinical data, today's restoratives have an average half-life of 17-22
years, which is very close to a silver amalgam restoration and or porcelain fused
to metal crown. From a color stability perspective these products no longer have
residual oxide by-products, they tend to be very stable and tend to maintain their
anatomical form, contour and texture and overall physico-mechanical functional state.
So yes, there are still some materials today that are not very reliable, and then,
there are a few materials that are extremely advanced and are capable of rivaling
any metallurgical or ceramic adjunct material.
DR. JUDY JOHNSON (QUESTION): Would you say that while these materials might perhaps
be slightly more expensive, in the long run they save so much time that they work
out to be more economical?
SAMUEL WAKNINE DDS (ANSWER): Well, cost is certainly one element, but in today's
society people are more health conscious and aesthetically aware, which are also
factors that need to be considered. I think that a silver restoration for a posterior
molar tooth is 50/50. No one looks back there so it may not be too important. However,
for an anterior restoration there is really no choice in the matter, the thought
of seeing gold or silver as you smile is rather awkward, therefore, more aesthetically
pleasing materials become a matter of necessity. So for the anterior sector of the
intra-oral environment it is a necessity. Furthermore, as far as the laboratory
technician is concerned, modern materials are quicker and easier to use so there
is really no reason why they should not be chosen.
DR. JUDY JOHNSON (QUESTION): Could you tell us a little about the history of dental
restorations and the advances that have been made in recent years?
SAMUEL WAKNINE DDS (ANSWER): Traditionally, metallurgical materials were used for
restorations. This was a very well established practice for the best part of 150
years. In the case of fillings, silver amalgams were used to a large extent worldwide.
These amalgams are 50 percent powder - composed of silver, tin, copper and a trace
amount of zinc, and 50 percent liquid - which is pure mercury - amalgamated to form
a paste, which is placed into the cavity. The silver amalgamates by reacting with
the free mercury, while the copper interacts with the tin to create a cupric-tin
complex strengthening/hardening interphase and the zinc acts like a scavenger to
rid any unreacted metallic oxide residue. This material is not very technique sensitive,
with near zero handling/manipulation error characteristics, so it's advantageous
to the clinician due to the fact that it can be placed in a slightly moist environment,
forgiving to isolation technique acuity, in lieu of deleterious effects to its tooth-margin
interfacial integrity. However, there are serious disadvantages to this type of
silver amalgam material in comparison to the modern poly-ceram composite fillings.
The silver amalgam is not tooth colored and is rather obvious when placed in the
anterior sector of the oral environment. However, the modern poly-ceram composite
can attain a near perfect tooth color match. Further, in the event the silver amalgam
is applied beyond one third of the cuspal incline, it tends to undermine the surrounding
thin-walled remaining enamel leading to cuspal fracture and/or radial cracks compromising
the retentive surrounding tooth aspects, or the restoration itself. The poly-ceram
is capable of achieving a chemical bond-linkage to the underlying organic dentin
and a micro-mechanical bond to the surrounding enamel honeycomb prismatic structure
with the aid of modern seventh generation adhesive technology.
This allows for a more conservative approach to tooth preparation guidelines criteria,
with a greater emphasis on conservation of sound non-carious tooth structure. Conversely,
such advances in adhesion technology have allowed for more substantial, larger restorations,
in lieu of hampering the strength of the remaining tooth structure, especially with
the advent of extra-oral processed inlay-onlay (three-quarter)-crown luted cemented
The metallurgical silver-amalgam product is electrically conductive, so it is not
the most pleasant material to have in your mouth. By contrast, the poly-ceram composite
filling is electrically non-conductive. The silver amalgam also undergoes an abrasion
phenomenon leading to degradation, allowing the leaching of certain mercuric contents
from the filling, which have been known to affect certain kidney and liver enzymes
and even permeate the blood brain barrier. Although, the mercuric salt differs from
the free mercury in its unamalgamated form, this remains a controversial issue.
Whereas the poly-ceram composites of the 1960s ensued upward of 150 micron wears
per year, today's (circa 1993-2003) modern poly-ceram composites are able to sustain
a clinical wear rate of 3-35 microns per year, a pivotal improvement. The corrosion
by-product of the dental silver amalgam serendipitously seals the tooth restoration
margin, in lieu of chemical adhesion, otherwise known as the Gamma-II Phase. In
order to passivate this corrosion phenomenon, both marginal breakdown, surface pit-corrosion
patterns and tarnish, high copper amalgams were innovated, however, a clear disadvantage
of the accentuation of the Gamma-I Phase is that it leads to more prevalent bulk
fracture and facilitated mercuric salt by-product release.
The G.V. Black rules of cavity preparation protocol innovated in 1898, and still
practiced today, state the necessity of 'extension for prevention', in other words
extending the cavity preparation/excavation beyond the carious limit zone in order
to prevent recurring caries, thereby, consuming more tooth structure. In addition,
due to the fact that silver amalgams do not chemically adhere to tooth structure,
creating diatoric forms, undercuts, channeling and macro-mechanical retentive sites
during the cavity preparation is both necessary to retent the amalgam as well as
deleterious in sacrificing more sound tooth structure. On such occasion that the
tooth preparation has been compromised to a great extent, the tendency is to use
gold retentive pins in order to anchor and sustain the silver-mercury admix, a further
unnecessary invasive step. Previous research has shown that a silver amalgam 'MOD'
3-surface, slot-like cavity preparation, restored class II molar tooth, sustains
only 50 percent of a sound unrestored molar intercuspal flexural strength. Further,
a modern poly-ceram composite restoration strengthens the tooth to 2xfold its potential
intercuspal transverse strength. Silver amalgams used in large class II molar restorations;
invariably cause a tattoo phenomenon of permanent tooth discoloration to a violet-gray/green
tinge and even brown/black tint, this is quite evident when a clinician attempts
the removal, replacement or repair of a failing old silver-amalgam restoration.
This is not the case with modern poly-ceram composite filling materials. As a consequence,
such restorations have, over the past 20-25 years, become less and less popular
and alternatives, otherwise known as bonding or white fillings (or more prevalently
known as composites) are now available.
DR. JUDY JOHNSON (QUESTION): Could you tell us about your particular area of specialty?
SAMUEL WAKNINE DDS (ANSWER): At DRM Research Labs our area of specialty lies with
these alternative restorations, which are composed of polymeric materials and glass
ceramic fillers for reinforcement. Such restorations are used for a plethora of
intraoral care including liners, cement, sealants, class V cervical erosion sites,
and direct fillings, class I, II, III and IV in anterior and posterior tooth restoration.
They were originally available in auto cure format (2-part systems) throughout the
1950-60s, then in photo cure UV-light initiated (200-400 nanometers). In the early
1970s and in the late 1970s the entire industry merged to photo cure blue or halogen
light cure materials, which are initiated by a blue light ranging from 400 to 700
nanometers wavelength irradiated for 10-40 seconds. The light triggers a free-radical
addition reaction in the material that converts it from a monomer (liquid state)
to a polymer (solid form), hardened material.
Such materials have experienced a lot of problems, most of which have been resolved
over the years, as the technology has become more refined. Our area of concentration
and original innovation is the semi-crystalline poly-ceram nano-reinforced technology,
and the particular line adjunct and borne of this pivotal innovation is the Diamond
product line. There is an entire series affiliated with this ranging from the advanced
adhesive, DiamondBond, the liner/cement/sealant, DiamondLink, the filling material,
DiamondLite to the prosthodontic, crown and bridge system, DiamondCrown. It is the
crystalline morphology and special oligomer-ceram interfacial characteristics that
affords these materials certain physical, mechanical, optical and wear resistance
properties that rival the standard amorphous polymer composites.
This special technology has afforded improved color stability, better tooth color
matching ability, significantly higher fracture strength resistance, near-zero leaching/solubility,
tremendous wear resistance, negligible polymerization-contraction forces, shrinkage,
substantially improved tooth-adhesive marginal integrity due to advanced bonding
mechanisms, biocompatible formulation and remarkable toughness, shock absorbing
character, carrying this technology above the norm of the restorative niche into
the realm of reconstructive materials, including prosthetics and implantology.
Of special interest is field prosthodontics and implantology due to the fact that
the traditional superstructure encapsulating or crowning the underlying metallic
alloy substructure is usually dental porcelain characterized as a very hard and
brittle surface that is relatively unforgiving and complex in its laboratory application
methodology. The PFM (porcelain fused to metal) restoration, although very popular,
is infused with a spectrum of relative disadvantages:
i. The mechanical properties of dental porcelain exhibit an unusually hard material,
four times that of natural tooth structure, which is rather non-forgiving, wears
opposing dentition, weak in tension and flexure mode (low strength), and most importantly
attains very low toughness, hence, unable to dissipate cyclic masticatory energy.
Therefore, it is prone to fracture, delamination from the underlying retentive metal
framework, eventually necessitating complex intra/extra-oral repair.
ii. This is further complicated by the use of popular dental alloys as the copings
or frameworks for these dental porcelains such as nickel chrome and silver-palladium,
which have been documented to ensue cytotoxic reactivity with the intraoral epithelial
mucous membrane soft tissue contact zones, leading to cervical erosion, pocket formation,
degradation of the interdentinal papillae and loss of periodontal ligature attachment,
accelerating mobility and jeopardizing the overall stability of tooth structural-architectural
iii. The underlying metallic substructure lack of aesthetic quality or tooth color
matching ability necessitates greater tooth structure compromise in order to plunge
the metallic collar of the crown restoration, yielding a cervical margin below the
gingival gum-tissue line, sub gingival. This leads to further bio-interaction at
the sulcus with perio-ligature deterioration and poor hygienic maintenance due to
inaccessibility to tooth brushing and dentifrice activity.
iv. These factors collectively are of great ramification when such materials, dental
porcelain, are used in implant prosthodontics. Especially in single implants and
the more popular immediate loading techniques, where the shock absorbing, high toughness,
form and functional maintenance coupled with superb aesthetics of the semi-crystalline
poly-ceram nano-reinforced DiamondCrown technology rivals any dental porcelain titanium
implant superstructure. This is of great importance in particularly frail osseo
integration transitional implant-prosthesis (crown) loading periods that will dictate
the eventual success rate of the implant prosthesis integration and maintenance
Further, in complicated cases where temporomadibular joint disorder is prevalent
and eventual characteristic tooth bruxism and jaw-clenching phenomena are evident,
the semi-crystalline DiamondCrown technology, serves its purpose par excellence
as the restorative of choice for occlusal rehabilitation. Whereby the shock-absorbing,
cyclic masticatory energy dissipating special micro morphology of the crystalline
lamellae leads to a micro elastic behavior, the reinforcing poly-ceram interdendritic
structure allows for macro rigidity and architectural stability in spite of the
tormented occlusal disappropriation. Further, enhanced by the ability to repair
and maintain intra-orally opposed to the standard of the industry, dental gold.
DR. JUDY JOHNSON (QUESTION): Would it be advisable to undertake specific training
before using the new restorative materials?
SAMUEL WAKNINE DDS (ANSWER): Yes, training and education is a key factor in disseminating
the proper methodology and operative techniques affiliated with this new generation
of materials. The learning curve associated with the older generation metallurgical
materials, from an intra-oral placement care point of view, is not very steep, so
in order to become more adept at this type of restorative dentistry, it is very
important to hold clinics, workshops and get-togethers or even chair-side practical
workshops to bring about greater awareness as to what is the proper either surgical,
operative or technical protocols that bring about a higher chair-side success rate,
their corresponding clinical indications and material ramifications.
DR. JUDY JOHNSON (QUESTION): Who would conduct these workshops?
SAMUEL WAKNINE DDS (ANSWER): We actually conduct these workshops with an entire
team of technologists, clinicians and scientists. We go from country to country
and attempt to help generate a greater awareness of the proper clinical methodologies
associated with advanced biomaterials chemical engineering. It's the education!
"That's what brings about the real success in this restorative science."
Write DR. SAMUEL WAKNINE, C/O NYC Dental Visits Midtown Manhattan Center for Cosmetic