EGP-MA19

A Call to Serve

How can DSOs deliver the best care possible?

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Editor’s Note

The Big Picture...................................................................................... 4

Faster, Easier, Better Cone beam technology and 3D printing continue to be game-changers for dentists and patients alike............................ 30

Meet the Efficiency in Group Practice Dental Implants 2019 Editorial Board ............................................................6 Newer technology has made implants simpler and more accurate........ 32 Women’s Influence in Dentistry It’s not just about more women in leadership roles; it’s also about a better balance of male and female characteristics in the industry......... 8

How can DSOs deliver the best care possible?................................... 14

As researchers continue to make a connection between oral health and chronic disease, the question begs: What will this mean for dental professionals?.................................... 20

Growing Pains Culture, clarity and talent development help define a DSO, especially as it grows in size................................ 26

Kristine Berry, RDH, MSEC, Senior Consultant Brad Guyton, DDS, MBA, MPH, Vice President, Clinician Development, Dean, PDS University™ – Institute of Dentistry, Pacific Dental Services Brandon Halcott, Co-Founder and President, Tru Family Dental DeAnn McClain, Executive Vice President of Operations, Heartland Dental Kasey Pickett, Sr. Director, Communications, Aspen Dental Management, Inc Heather Walker, DDS, Mortenson Family Dental

In Good Company

Shedding light on practicing hygiene in corporate dentistry................ 44

Oral Arguments

EDITORIAL BOARD

Boot Camp 101!

Personal Protective Equipment........................................................... 38

A Call to Serve

A.J. Acierno, DDS, CEO, DecisionOne Dental Partners

2019 OSAP Annual Conference............................... 36

Industry News: Proof Positive Burkhart’s Proven Solutions Center helps dental practices make the right equipment decisions...................................... 50

News............................................................................................. 54

EDITOR Laura Thill • lthill@sharemovingmedia.com MANAGING EDITOR Graham Garrison • ggarrison@sharemovingmedia.com ASSOCIATE EDITOR Alan Cherry • acherry@sharemovingmedia.com CIRCULATION Laura Gantert • lgantert@sharemovingmedia.com ART DIRECTOR Brent Cashman • bcashman@sharemovingmedia.com

ADVERTISING SALES Diana Partin dpartin@sharemovingmedia.com ADVERTISING SALES Jamie Falasz, RDH jfalasz@sharemovingmedia.com

Efficiency In Group Practice is published six times a year by Share Moving Media • 1735 N. Brown Rd. Ste. 140 Lawrenceville, GA 30043-8153 Phone: 770-263-5257 • Fax: 770-236-8023 www.dentalgrouppractice.com

Efficiency In Group Practice is published six times a year by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2019 by Share Moving Media All rights reserved. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address.

POSTMASTER: Send address changes to Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publishers. Publishers cannot accept responsibility for the correctness of an opinion expressed by contributing authors.

ISSUE 2 • 2019 : DentalGroupPractice.com

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Editor’s Note

The Big Picture

Laura Thill

Dental technology is better than ever, and new surgical treatments are always on the horizon. Yet, for many, even the most basic care is out of reach.

More and more dentists are taking advantage of cone beam and CAD/CAM, which means shorter chair times for patients and more precise results. And, while 3D printing is still relatively new, some dentists believe it could eventually make milling obsolete. “Today, we only print plastic,” says Michael Fulbright, DDS, owner of Fulbright Cosmetic and Reconstructive Dentistry, Redondo Beach, California. “As the materials catch up to the technology, I expect we’ll eventually move away from milling and start printing porcelain crowns and implants.”

And that’s only the beginning. Recently, a Tufts University team constructed a cellular matrix that allows successful implantation of a tooth bud into a pig’s jaw, according to Thomas Hirsch, DDS, the owner of a Malibu, California-based dental practice and founder of Isolite Systems, currently Zyris. “Under their design, early adult-stage teeth develop within five months,” he says.

“Researchers project that humans won’t profit from these developments for another ten years. But, the exciting progress hints at options once believed to be impossible.”

But, not everyone is – or will be – privy to options such as these. A good number of patients miss dental appointments, often for several reasons, according to John Barnes, DDS, government affairs clinical chair, Pacific Dental Services. “The obstacles limiting access to dental care include cost of care, patients’ lack of perceived need and possibly limited oral health care resources in some rural areas,” he explains. “Many patients are episodic patients, meaning they seek care when they have a problem and don’t understand the value of preventive care on a continuing basis. When a problem does arise, however, it is typically expensive to resolve.”

The good news is that with the rise of DSOs over the past decade, large, multi-site dental practices are learning to operate – Michael Fulbright, DDS more efficiently to address a broader range of patients and needs.

To deliver great care, the people within an organization must feel compelled to serve others, according to Bill Becknell, CEO, Mortenson Dental Partners. They must be clear on the vision of the DSO and their role in supporting that vision, he points out. For a DSO to be truly efficient, however, several factors must be in place, he points out: culture, clarity and talent development.

In this issue, EGP has reached out to a number of experts on several topics. Each article provides a snapshot of the industry. Together, however, they paint a much larger picture of dentistry – the direction in which it’s headed and the role DSOs can and will play.

“ As the materials catch up to the technology, I expect we’ll eventually move away from milling and start printing porcelain crowns and implants.”

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Efficiency In Group Practice : ISSUE 2 • 2019

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Editorial Board

Meet the Efficiency in Group Practice 2019 Editorial Board

6

A.J. Acierno, DDS, CEO, DecisionOne Dental Partners

Kristine Berry, RDH, MSEC, Senior Consultant

Brad Guyton, DDS, MBA, MPH, Vice President, Clinician Development, Dean, PDS University™ – Institute of Dentistry, Pacific Dental Services

Brandon Halcott, Co-Founder and President, Tru Family Dental

DeAnn McClain, Executive Vice President of Operations, Heartland Dental

Kasey Pickett, Sr. Director, Communications, Aspen Dental Management, Inc

Heather Walker, DDS, Mortenson Family Dental

Efficiency In Group Practice : ISSUE 2 • 2019

Practice Points

Women’s Influence in Dentistry It’s not just about more women in leadership roles; it’s also about a better balance of male and female characteristics in the industry.

This is a tremendous moment in history for women. Although there’s still work to be done to create global gender equality throughout the world, women in the dental industry have incredible opportunities for breaking out of traditional roles – largely due to the efforts by women in the industry who have come before them. As they do so, the entire industry – male and female – will benefit.

By Kristine Berry, RDH, MSEC, Executive Coach Kristine Berry is an international speaker and executive coach, specializing in enhancing group practices.

Looking for a speaker or coach, she invites you to contact her via email at kristine@kristineberry.com or visit her website www.kristineberry.com

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The question is, given the state of play within the leadership ranks, and the succession planning of dental organizations and dental practices, how will the influence of women be fostered and progress within the dental industry?

This article will explore what leadership is from the behavioral psychology, trade and gender-related research of masculine and feminine traits, or – in terms more familiar to some – transactional leadership and transformational leadership.

What is leadership?

In my view, leadership at an individual level is a decision, a mindset. It is not a title or position. I believe we can lead, positively influence, serve, call others to action and create change from wherever we are.

Some of you lead because you are CEOs, regional managers, directors, VPs, involved

Efficiency In Group Practice : ISSUE 2 • 2019

in business development, social media or marketing superstars, entrepreneurs or speakers. You are standing in public and/or have external facing leadership roles. Other women in dentistry work quietly in the background in supportive roles, yet they have tremenedous influence shaping the direction and values of their associations, offices, departments and/or companies.

Over the course of our professional careers, we see a multiplicity of leadership styles and approaches to leadership that are shaped as much by people’s personality as by their backgrounds, education, life journeys, gender, ethnicity, sexual orientation, emotional intelligence and empathy skills, performance anxiety or psychologicial threats, flight or flight responses, disabilities, vision, need for safety, need for belonging and personal standards of excellence, to name but a few. Behind our individual leadership is a complex blend of ingredients that makes us unique, including a core set of values that drive our purposeful work in leadership.

If we are to be leaders who serve and lead others, we must first understand and lead ourselves and practice checking in on whether we are living up to our own

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Practice Points

leadership principles. On a basic level, we must have an understanding of our internal triggers and biases about our masculine and feminine energy traits. These traits, either embraced or denied, will influence how we perceive the world and our vision of what can and must be, our place and role in it, and the actions needed to make that vision our reality.

Leadership reimagined The challenge of leadership is to be able to re-imagine the traditions – that which has always been. There is a groundswell of conversation and vigor driving those who hold the formal power, influence and money to reflect and be cognizant of the people they serve and the employees they represent. For instance, we can learn from statistics that tell us more dentists will retire in the next three years than ever before, and most of them are white male solo practitioners; or, we can learn from the fact that more than 50 percent of graduates are female, or that among the 198,517 dentists practicing in 2017, 31 percent were female; of that 95 percent of the nation’s dental hygienists are female as are 94 percent of dental assistants and office managers.

For me, these trends don’t reveal the feminization of the industry. The drive for diversity is trending, but not at every level, including corporate boardrooms, as part of investment or senior executive teams, regional or special market groups, practice ownership, C-suite positions and/or high profiled podium speakers. Restating the words of journalists Nicholas Kristof and Sheryl WuDunn, women in the world hold up half the sky. The single most significant opportunity in dentistry is to create opportunities for women across the industry.

The book, The Athena Doctrine: How women (and men who think like them) will rule the future, by John Gezerma and Michael D’Antonio, recounts the results of a global research initiative they conducted in 2011 investigating how the world defined traditional feminine/ masculine qualities and leadership. In a global survey of 64,000 people across 13 countries that represent 65 percent of the world’s GDP (including Brazil, Canada, Chile, China, France, Germany, India, Indonesia, Japan, Mexico, South Korea, UK and USA), the authors report that 66 percent of participants agreed “the world would be a better place if men thought more like women.” Gezerma and D’Antonio note that countries with higher levels of feminine thinking/ leadership behavior have a higher per capita GDP and a higher quality of life.

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Efficiency In Group Practice : ISSUE 2 • 2019

Additionally, a 2014 Peterson Institute for International Economics white paper found the bottom line of companies with women in corporate leadership (i.e., CEO, board and other C-suite positions) is associated with a one-percentage point increase per net margin, which, for a typical firm, translates into a 15 percent increase in profitability. And companies that have women in leadership roles are showing higher performance assists, revenues and stockholder value.

Defining masculine and feminine traits To determine masculine and feminine traits, Gezerma and D’Antonio did two separate studies. In the first study, participants were asked to classify human behavioral traits as masculine, feminine or neither (Figure 1). In the second study, another group of participants received the same list of words, without credit of gender, and were asked to rate their significance to certain virtues: leadership, success, morality and happiness. When they statistically compared the samples, they could see that across age, gender and culture, people around the world feel that feminine traits correlate more strongly with making the world a better place!

The following, according to the authors, are the top qualities for the ideal modern leader: • Connectedness.

• Humility.

• Candor.

• Patience.

• Empathy.

• Trustworthiness.

• Openness.

• Flexibility.

• Vulnerability.

• Balance.

Masculine and feminine leadership According to other researchers’ empirical studies on behavioral psychology and gender-related research, masculine energy is about doing, while feminine energy is about being. When the masculine energy sees or encounters a problem, the sole goal is to find a solution. When the feminine energy sees or encounters a problem, there is a sincere desire to share and connect. The masculine energy wants to hunt, pursue and chase; it wants to be needed. The feminine energy wants to be sought after, pursued, cherished and honored, and to feel safe, seen and understood.

The masculine energy is analytical, impatient, assertive and logical; it moves with a dominant single-mindedness.

It generally focuses on one task or issue at a time, concentrating its attention on a singular focus. The feminine

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Practice Points Figure 1. Human Behavioral Traits Male Traits

Female Traits

Traits Reflecting Both Males and Females

Aggressive Analytical Assertive Career Oriented Committed Decisive Different Emotional Focused Hard working Intelligent Loyal Overbearing Reasonable

Agile Arrogant Authentic Charming Competitive Dedicated Direct Empathetic Free Spirited Healthy Leader Nurturing Passive Reliable

Ambitious Articulate Candid Collaborative Cunning Dependable Dominant Energetic Fun Helpful Logical Original Proud Rigid

Rugged

Simple

Strong

Team Player Traditional Visionary Source: Gezerma, J. & D'Antonio, M. (2013). The Athena Doctrine. San Francisco: Jossey-Bass. energy is nurturing, understanding and all about intuition and feeling. It feels and sees everything, continuously multi-tasks and processes everything at once.

All people have both masculine and feminine energy traits. The way in which we call upon these assets contributes to our individual style of leadership. The research suggests a balancing of stereotypical feminine and masculine traits vastly increases the capacity of both men and women to solve problems, lead/grow their teams and increase their enterprise’s profits. This is not a male-versus-female issue. Men can be as caring as women, and women can be as analytical and assertive as men. Our gender is who we are conditioned to be, rather than what we can be. We must all see feminine values not as belonging to one gender, but as a new form of innovation for today’s world. According to Howard Morgan and Joelle Jay, authors of “The New Advantage: How Women in Leadership Can Create Win-Wins for Their Companies References:

and Themselves,” women in leadership and implementing feminine assets is a global competitive advantage.

If we want to foster women’s leadership and advancements in the dental industry, we need to re-imagine a world in which a new leadership model exists. We need to rethink and reshape what women’s leadership looks like in dentistry.

Seasoned women leaders must analyze their leadership values, practices and structures and consider what they are doing to sponsor the next generation of leaders. All leaders – both male and female – must ask themselves if they are excluding any populations or groups from embracing leadership.

We must expand our concept of leadership and what it should look like. As experienced leaders, we must acknowledge that to remain relevant and make a positive change in oral healthcare, we must face the truth that we do not have all the wisdom that is required in today’s world. We must draw on the wisdom of women leaders from across all walks of life.

Gezerma, J. & D'Antonio, M. (2013). The Athena Doctrine. San Francisco: Jossey-Bass.

Gilbert, E. (2015). Big Magic. New York: Riverhead Books.

Jironet, K. (2011). Female Leadership. London: Routledge.

Morgan, H. J. & Jay, J. K. (2016). The New Advantage: How Women in Leadership Can Create Win-Wins for Their Companies and Themselves. Santa Barbara: PRAEGER. O'Reilly, N. D. (2015). Leading Women: 20 Influencial Women Share Their Secrets to Ledership, Business and Life. Avon: Adamsmedia.

Orser, B. & Elliott, C. (2015). Feminine Capital: Unclocking the Power of Women Entrepreneurs. Standford: Standford University Press 12

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Efficiency In Group Practice : ISSUE 2 • 2019

A Call to Serve How can DSOs deliver the best care possible?

Without proper attention and care, a sick or damaged tooth or periodontal disease will not get better. As clinicians know too well, it likely will worsen, necessitating more extensive treatment.

Patients miss dental appointments for a number of reasons, according to John Barnes, DDS, government affairs clinical chair, Pacific Dental Services (PDS). “The obstacles limiting access to dental care include cost of care, patients’ lack of perceived need and possibly limited oral health care resources in some rural areas,” he explains. “Many patients are episodic patients, meaning they seek care when they have a problem and don’t understand the value of preventive care on a continuing basis. When a problem does arise, however, it is typically expensive to resolve.”

Indeed, without the necessary treatment, the patient’s condition will continue to deteriorate, Barnes continues. “A fractured tooth that may have been able to be saved with a filling or crown will advance and require root canal therapy or perhaps even extraction,” he says. “Untreated gum disease can advance into tooth loss and, more importantly, adversely affect the patient’s overall systemic health. It is becoming more evident that periodontal disease is related to several chronic medical conditions, including heart disease, diabetes, dementia, stroke and cancer.”

Connecting with patients Most patients find a local dentist by searching the Internet or acting on a referral by a family member or a friend, notes Barnes. Sometimes, however, in extreme situations, they find themselves in the emergency room or at an urgent care center.

“Many PDS-supported offices have developed relationships with nearby ERs and urgent care centers and do receive referrals from them,” he says.

In other cases, dental team members either know of someone in need, or the dental practice works with local organizations to identity hard-toreach patients, he points out. “Some examples of these organizations include Genesis Women’s Shelter in Dallas, Texas; Dress for Success in Houston, Texas; Mission of Mercy in Phoenix, Arizona and countless others around the country,” he says.

Caring for patients with limited access Barnes believes there is a much more defined culture of giving back today, compared to the past. “Whether it is an individual dentist, a dental practice team member or a large DSO such as Pacific Dental Services, I see

John Barnes

“ Many patients are episodic patients, meaning they seek care when they have a problem and don’t understand the value of preventive care on a continuing basis. When a problem does arise, however, it is typically expensive to resolve.”

– John Barnes, DDS, government affairs clinical chair, Pacific Dental Services

ISSUE 2 • 2019 : DentalGroupPractice.com 15

A Call to Serve

more giving to those in need than ever before,” he says.

“It feels good; it is satisfying and gives an important sense of purpose to those serving others.”

For instance, the Pacific Dental Services® Foundation typically partners with local PDS-supported practices to serve patients with limited access to care. “We provide care in several ways,” Barnes explains. “The individual-supported office may treat these patients free of charge throughout the year, as determined by the practice owner. Also, each year, on a given Saturday in August, most PDS-supported practices participate in Smile Generation® Serve Day. They identify patients in need and provide them with free dental services. This has resulted in millions of dollars of free dentistry performed across the country.

“The Pacific Dental Services Foundation also funds and equips a mobile dental clinic – a mobile, two-operatory

equipped RV with PDS-supported dentists and team members who volunteer to serve these patients in need,” he adds.

Barnes anticipates that more underserved patients will receive necessary treatment in years to come, particularly with the emergence of mid-level dental providers.

Similar to physician assistants and nurse practitioners in the medical profession, mid-level dental providers will be able to provide limited services under the supervision of a dentist, notably expanding access to care, he explains.

For the present time, lawmakers, dental boards, organized dental associations and dentists continue to debate the logistics and value of such programs. But, as attention to underserved populations continues to grow, the industry is certain to reach this point in the not-too-distant future, he notes.

Who are underserved patients?

The definition of underserved is not precise, but generally includes five populations of patients.

1. Patients with family incomes below 200 percent of the federal poverty level. This group accounts for the largest number of underserved and tends to have low utilization of dental services and poor oral health.

2. Patients with medical disabilities or chronic illness. A significant percentage of the population has physical or mental disabilities that make it difficult for them to travel to dental offices and to find dentists who have the special clinical experience to treat them.

3. Patients residing in geographically isolated or medically underserved areas. In rural areas of the country there are relatively fewer dentists per capita. This makes it more difficult to schedule visits with dentists and to travel to their offices. In many urban areas, there is

a maldistribution of dentists willing to serve vulnerable populations.

4. Patients with limited literacy. Over a million new immigrants enter the United States annually, and many have language and cultural barriers to accessing dental care. Other residents may have low literacy skills and be unable to navigate the healthcare system.

5. Patients confined to residential settings.

Millions of Americans are confined to longterm care facilities (e.g., nursing homes, prisons and chronic care facilities for the mentally and physically disabled). Most of these institutions provide limited, if any, dental care, and patients are too poor to obtain care privately.

There is considerable overlap among these five population groups, so a significant number of Americans face one or more of these barriers.

Source: Pipeline, Profession & Practice: Community-Based Dental Education, a national program supported by the Robert Wood Johnson Foundation in collaboration with The California Endowment and the W.K. Kellogg Foundation. For more information visit http://www.dentalpipeline.org/au_aboutus.html.

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Efficiency In Group Practice : ISSUE 2 • 2019

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Trends

Oral Arguments As researchers continue to make a connection between oral health and chronic disease, the question begs: What will this mean for dental professionals?

Researchers continue to connect the dots between oral health (particularly periodontal disease) and other chronic conditions, such as diabetes, heart disease and asthma. Payers, regulators and providers are getting the message.

Here’s what’s happened in dental/medical research in the last year and a half.

•O ctober 2018: Dominion National, a dental insurer and administrator of dental and vision benefits headquartered in Arlington, Virginia, released a study indicating people with chronic health conditions such as asthma, diabetes and heart disease who received preventive dental care covered by Capital BlueCross’ BlueCross DentalSM benefits had fewer emergency room visits and hospital stays.

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Efficiency In Group Practice : ISSUE 2 • 2019

• February 2018: After reviewing meta-analyses of clinical trials, researchers from the University of Athens (Greece) School of Dentistry reported in the Journal of Clinical Periodontology that periodontal treatment improves glycemic control in people with diabetes. Patients who underwent periodontal treatment had about half a percent lower HbA1c levels three months after treatment than those who did not receive periodontal therapy.

• November 2017: Data from a Medical Expenditure Panel Survey (MEPS) revealed that when a preventive dental benefit was provided for adult Medicaid recipients, medical costs for people with chronic conditions were lowered from 31 to 67 percent.

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Trends

• September 2017: Dental insurer United Concordia released a study examining the medical benefit when an individual absent a chronic medical condition regularly sees their dentist two times a year for checkups and cleanings, compared to those who do not.

More covered mouths More people than ever are covered by dental insurance, reports the National Association of Dental Plans. The percentage of the population with dental insurance – either commercial or public (Medicare, Medicaid, and the Children’s Health Insurance Plan, or CHIP) has increased from 58 percent in 2008 to 78 percent in 2017.

“The public sector is the big news,” says Evelyn Ireland, executive director, NADP. Due to expansion of the number of adults covered by Medicaid, and growing participation in Medicare Advantage (which frequently includes dental coverage), the number of Medicaid and Medicare recipients receiving dental coverage grew from about 36.6 million in 2014 to 87.8 million in 2017. (Meanwhile, the number of people with commercial dental insurance grew steadily during that same period, from 155.9 million in 2014 to 166.2 million in 2017.)

In 2016, Washington, D.C.-based consulting firm Avalere Health released a study conducted on behalf of Pacific Dental Services Foundation indicating that by adding a periodontal benefit to Medicare Part B, the Medicare program would save $63.5 billion over the period 2016 to 2025 in reduced hospitalizations and emergency room visits by individuals with periodontal (gum) disease and medical conditions, e.g., diabetes, coronary artery disease and cerebrovascular disease.

“Research is ongoing and results continue to solidify the evidence of a biological link between periodontitis and [diabetes, coronary artery disease and cerebrovascular disease],” reported Avalere. “While much about these links remains unknown due to biological complexity and the limitations of research design and resources, data suggest that improving periodontal health may have a positive impact on health outcomes….”

Approximately 45 percent of adults aged 30 years and older – and an estimated 66 percent of adults 65 years and older – have some form of periodontal disease, Avalere pointed out, citing research published in the Journal of Periodontology.

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Efficiency In Group Practice : ISSUE 2 • 2019

Medical cost savings In November 2017, Avalere’s findings for Medicare were replicated in the Medicaid program by a Medical Expenditure Panel Survey (MEPS) conducted by researchers at the Department of Public Health, University of Maryland School of Dentistry, on behalf of the National Association of Dental Plans.

Researchers studied the relationship between the cost of medical care when Medicaid recipients (ages 25-64) with chronic conditions received preventive dental care.

“It’s a good indication that dental benefits keep medical costs down and help manage overall costs,” says Ireland.

Dental insurance facts • Twenty-two percent of Americans have no dental benefits.

• Thirty-five percent of the uninsured are over 65.

•M ost of the remaining uninsured are employed in businesses that do not offer dental coverage.

•A small fraction of the population has access to dental benefits but do not purchase coverage.

•A little more than half of the population gets dental benefits in the private market – through employers or by purchasing as an individual.

• Less than 4 percent of the population has individual coverage for dental services.

• Just over a quarter of the population gets dental benefits through a public program, i.e.

Medicaid, CHIP, Medicare Advantage, or other public programs like Indian Health Services.

• A segment of the senior population has maintained coverage from prior employment, and some purchase dental benefits as individuals outside of Medicare Advantage plans Source: NADP 2018 Dental Benefits Report: Enrollment, October 2018 Endodontics (https://www.aae.org).

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The research showed that health expenditures for recipients who received preventive dental care were lower than those who did not: • Coronary heart disease: 67 percent lower.

• Diabetes: 36 percent lower.

• High blood pressure: 31 percent lower.

• Heart attack: 36 percent lower.

• Stroke: 52 percent lower.

• Angina: 45 percent lower.

• Other heart disease: 45 percent lower.

• Cancer: 67 percent lower.

• High cholesterol: 43 percent lower.

• Asthma: 37 percent lower.

Private pay Commercial insurers are studying the medical/dental connection closely.

The Dominion National study was conducted over a two-year period in partnership with Capital BlueCross and Geneia.® The study analyzed paid claims between July 2015

and June 2017 for individuals with and without BlueCross DentalSM coverage who had a diagnosis of one or more of the following conditions: asthma, cerebrovascular disease, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, diabetes, maternity, osteoporosis, renal failure and rheumatoid arthritis.

The research compared medical costs and utilization of Capital BlueCross members with chronic conditions and BlueCross Dental coverage who received preventive dental services, versus those who did not receive preventive dental services. It found: • People with chronic conditions – but no BlueCross Dental coverage – had a 7 percent higher incidence rate of inpatient hospital stays than those with BlueCross Dental coverage who received a preventive dental service.

• Those who had BlueCross Dental coverage – but did not receive preventive dental services – had a 19 percent higher incidence rate of emergency department visits than those with BlueCross Dental coverage who received preventive dental services.

ISSUE 2 • 2019 : DentalGroupPractice.com 23

Trends

“The findings of this study reinforce how integrating with a chronic medical condition, such as diabetes or heart medical and dental coverage and care can be associated disease, seek and maintain treatment for gum disease. The with improved health and lower costs for those dealing company followed up that study with another to deterwith chronic medical issues,” Capital BlueCross President mine the medical value of visiting the dentist regularly, and CEO Gary St. Hilaire was quoted as saying. even for people without a chronic condition.

“The dental/medical connection has picked up The study population included more than 489,000 momentum in the past two decades,” says Dominion United Concordia and Highmark Inc. members with National Vice President of Marketing Jeff Schwab. The both medical and dental coverage between the ages of 4 company is in a unique position to study and act on that and 64. (United Concordia is a subsidiary of Highmark.) connection, as it not only provides dental and vision benStudy participants who visited the dentist routinely efits, but administers dental benefits on the part of medi(defined as two checkups a year that include an oral evalucal insurance providers. ation, and a cleaning or periodontal maintenance) for three “We’re eager to work with our consecutive years saw medical cost health plan partners to provide outsavings of $68 per person annually as reach to these high-risk individuals compared to those who did not see the to seek preventive, necessary dental dentist at all. The savings rose to $157 care and improve health outcomes,” annually over a three-year period for says Schwab. For example, Dominthose who went to the dentist reguion National can identify highlarly versus those who did so intermitrisk members (that is, those with a tently; $134 for kids ages 4-18; and chronic condition) who might ben$219 for adults aged 45 to 64. efit from a dental checkup. “We can “We’ve done a lot of research also help them find a dental home, on oral health and people with and ensure they receive information chronic disease and without chronic that emphasizes the importance of disease, as well as the association oral health.” between periodontal disease and – Jeff Schwab If there is one obstacle in conoverall health,” says United Connecting oral health and systemic cordia Chief Dental Officer Quinn health, it is the lack of integration between electronic Dufurrena, DDS, JD. At press time, United Concordia medical records and electronic dental records, says was engaged in research on the association between denSchwab. “Overall, oral health professionals and physital care and respiratory or ear infections, as well as the cians recognize the benefit of closing the information gap association between dementia and tooth loss. between them,” he says. Short of sharing patient records, “Studies point to an association between oral health primary care providers – particularly pediatricians – can and systemic health, but we can’t say there’s causation, and continue to promote dental care to their patients; meanthat’s an important distinction,” he says. “The research while, dentists can discuss the oral/medical connection to we – and others – are doing points to the fact that we’re their patients, help detect signs of several chronic health shining a light on something interesting and important. conditions through oral exams, and refer patients to the As time goes on, we’ll make more connections.” appropriate healthcare provider.

In the meantime, exciting developments continue to “Sharing data is a critical key to success in integrating occur, says Dufurrena. For example, the Harvard School of dental and medical care.”

Dental Medicine’s Initiative to Integrate Oral Health and Medicine is working with partners in academia and healthThe right direction care to develop ideas and conduct research around the inteIn 2014, United Concordia Dental published a study gration of oral health and primary care. Many medical and in the American Journal of Preventive Medicine showing dental schools are combining curricula, he adds. reduced hospitalizations are possible when individuals “It’s a direction that makes sense.”

“Oral health professionals and physicians recognize the benefit of closing the information gap between them.”

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Efficiency In Group Practice : ISSUE 2 • 2019

The commercial market Given the association between oral health and systemic health, combining medical and dental insurance coverage makes sense. But just how – and when – that will take place remains to be seen.

“Standalone dental benefits aren’t going anywhere,” says Jeff Schwab, Dominion National’s vice president of marketing. “Health plans recognize the need for a strong dental component, and a lot of them will look to standalone dental partners to administer their dental plan. It comes down to the bandwidth and resources of the carrier.”

A survey published by Chicago-based consulting firm West Monroe Partners in January 2018 found that 96 percent of insurance executives believe the embedding of dental benefits into medical plans is already happening, or will happen. Today, 99 percent of commercial dental

insurance plans are purchased through standalone dental insurers.

“Competitive margins and profitability, relative benefit simplicity, customer retention, and the increasing proof of correlation between oral health and overall health are driving more health insurers to experiment and invest in adding dental benefits to their plans,” the company said. “Convergence opportunities exist between health and dental insurers, especially as both face significant technical investments necessary to modernize core platforms and address consumer demands. As such, standalone dental insurance plans are attractive targets for health plans – either for acquisition or partnership. In fact, 100 percent of surveyed health plan executives whose companies don’t already offer dental benefits plan to do so in the near future.”

ISSUE 2 • 2019 : DentalGroupPractice.com 25

Trends

Growing Pains

Culture, clarity and talent development help define a DSO, especially as it grows in size.

By Laura Thill

To deliver great care, the people within an organization must feel compelled to serve others. They must be clear on the vision of the DSO and their role in supporting that vision, notes Bill Becknell, CEO, Mortenson Dental Partners. But as DSOs continue to grow, and multiple cultures, talents and operating philosophies merge, leadership must work hard to ensure that everyone within the organization is on the same page, he notes.

“A truly efficient DSO is one where each team member is aligned with the vision of the organization and utilizes their unique skills to ensure a great patient experience and optimum clinical outcomes,” says Becknell. “DSOs support doctors and practice teams, and as such, the role of the DSO is to remove and/or simplify administrative tasks at the practice level. This leaves more resources for the patient experience and delivering care. Ultimately, doctors have more time with patients and spend less time managing administrative duties; and employee engagement increases because they are doing the work they most enjoy.”

For a DSO to be truly efficient, several factors must be in place, he continues: culture, clarity and talent development. In any healthcare organization whose aim it is to deliver great care, clinicians and other employees must feel 26

Efficiency In Group Practice : ISSUE 2 • 2019

a calling to serve others, he explains. For them, their work is much more than just a job. “Culture refers to a caring for others and a service aptitude that cannot be trained or taught, but is an innate part of one’s personality,” he says.

“Certainly, this is the compelling reason most providers pursue a career in healthcare, but for DSOs it goes deeper than that. In order to deliver optimal healthcare, the team that surrounds the doctors and provides remote support must have a strong aptitude for serving others as well. By cultivating a culture that celebrates this commitment to service and empowers all team members to make the decisions that are best for the patient, the ability to operate efficiently follows.”

Furthermore, each team member must be clear on the DSO’s vision and know their specific role in supporting it, Becknell points out. “This sounds obvious, but most DSOs are growing, either through denovo or acquisitions,” he says. As a result, many cultures, talents and expectations come together, making clarity of the DSO’s vision a challenging goal, he notes.

Finally, efficient DSOs rely on a defined set of operating philosophies and the ability to communicate and disseminate information throughout the organization, says Becknell. As DSOs grow, however, they must move from a tribal knowledge mindset, where knowledge is passed

down from one generation to the next, to an approach where everything is defined and documented, and actions can be easily repeated. “This will not happen without an intentional process and investing in the proper mechanisms to support it,” he points out. Compounding this challenge, in a growing organization, such as a large DSO, everything moves and changes very quickly, he adds. “As such, processes are often being rebuilt and new systems are added. The entire process of best practices and education is regenerative. Investing in educating team members is critical to operating efficiently.”

share how they are exercising our mission and values with each other.

“One of the benefits of being part of a growing organization with many diverse participants is that we have a broad background to help us explore problem solving and innovation opportunities,” he continues. “Lastly, we have deployed a Learning Management System and the Google business suite, which helps us overcome some of the barriers of geography. Our supplier/partners have been very supportive of content for our in-person CE events.”

Planning ahead Addressing the challenges There are several challenges to achieving ultimate efficiency within the DSO, according to Becknell. First, Bill Becknell there is the matter of basic geography.

Once the footprint of the organization expands from one practice to two, everything becomes more complex, he notes. “The organization grows from one market to two or more,” he says. “Throw in a couple of acquisitions with similar – but different – cultures, and the clarity of mission and supporting philosophies of the business can quickly become challenged. It can also be challenging to intentionally pause and reevaluate your systems or processes, but this is necessary in order to grow upon a strong foundation. Sometimes, with rapid growth, foundational elements need to be improved in order to continue growing well.”

That said, there are products and services available to address the above obstacles. “For instance, at Mortenson Dental Partners, we are “very deliberate” in our communications, says Becknell. “And we communicate a lot,” he points out. “We have built an internal cadence of communication that ensures we all are connected, and we work together to solve opportunities as they arise. We have invested in an intranet that not only serves as an important communication channel; it’s also an excellent way to cultivate our culture and enable our team members to

To ensure the organization operates as efficiently as possible – today and moving forward – Mortenson Dental Partners conducts an annual strategic planning process: “We review our

“ A truly efficient DSO is one where each team member is aligned with the vision of the organization and utilizes their unique skills to ensure a great patient experience and optimum clinical outcomes.”

– Bill Becknell, CEO, Mortenson Dental Partners

business performance and trends, as well as the environmental situation,” says Becknell. “Then we identify necessary strategic projects. This process generally produces more ideas and opportunity than are accomplishable, so we must prioritize and identify those projects that will have the best impact on our future success.”

Realistically, it’s close to impossible for a DSO to accomplish all of the many projects on its to-do list. “We must focus on the most important ones,” says Becknell. “I believe the quickly evolving development of the DSO will continue over the next several years, requiring them to innovate at an accelerated pace compared to other businesses. This will make our environment both exciting and very rewarding.”

ISSUE 2 • 2019 : DentalGroupPractice.com 27

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The clock’s ticking on the U.S. Environmental Protection Agency (EPA’s) amalgam ruling compliance deadline. Dental offices, clinics, and schools have until July 14, 2020 to install amalgam separators in an effort to reduce the amount of metals (such as mercury) that end up in municipal sewage treatment plants.

As a DSO, this means that time’s running out to set offices up with the new technology.

It’s natural to be concerned about increasing profit while still being compliant, and it’s true that many dental supply companies require upfront capitol costs for amalgam separator equipment. This could add to one’s overhead while decreasing bottom line profit—but it doesn’t have to.

That’s where Dental Recycling North America (DRNA), a leading environmental compliance partner for the dental professional, can help. Their amalgam separator 28

Efficiency In Group Practice : ISSUE 2 • 2019

“Not only are there zero capital costs, but the first bill doesn't come until one year after installation.”

technology is free—yes, zero, nothmany offices in just six months ing, zilch—when combined with a in order to meet the compliance service agreement. deadline,” says Sussman. “Our free "Our model of providing equipequipment and one-year-out payment for free has been greatly appealment model solved the problem, and ing to organizations that want to now they can install immediately control costs,” says Marc Sussman, ahead of schedule". founder, president, and CEO of But DRNA’s cost-saving beneDRNA. “Not only are there zero capifits don’t end when the equipment tal costs, but the first bill doesn't come is in place. DRNA also offers comuntil one year after installation.” petitive recycling and cartridge costs, Considering that the market giving dental practices the ability to price of a standard amalgam separalock in an annual price with a five– Marc Sussman, founder, president, tor is about $850, you can easily calyear service agreement. This will and CEO of DRNA culate the savings for a large group help DSO offices budget for longpractice with many offices. And term recycling rather than having avoiding these initial costs can help practices get set up to deal with unpredictable costs. No unpleasant year-end in advance of the July 2020 deadline. (Who wants the surprises here! last-minute stress that comes with scrambling to meet the DRNA enables DSOs to save money now and in the new ruling?) future—it’s a win-win. They’ve already assisted the Cleve“One DSO office wanted to comply now but could land Clinic, U.S. Military, leading dental schools, and not get money budgeted until next January, which put other top dental groups in becoming compliant with the them in a time crunch as they’d have to rush to install new EPA rule—and they’re ready to work with you too.

ISSUE 2 • 2019 : DentalGroupPractice.com 29

Surgical Advances

Faster, Easier, Better Cone beam technology and 3D printing continue to be game-changers for dentists and patients alike.

By Laura Thill

In nearly the time it takes to make a pot of coffee and retrieve the morning paper from the driveway, some dentists can place an implant. While there’s no way to guarantee a perfect cup of coffee, however, that implant’s going to be darn close to perfect, if not spot-on.

Cosmetic and reconstructive specialist Michael Fulbright, DDS, owner of Fulbright Cosmetic and Reconstructive Dentistry, Redondo Beach, California, spends much of his day in surgery. His services range from implants and full-mouth rehabilitation to porcelain veneers, periodontal care and treatment for TMJ disorders and sleep apnea. “If there’s one thing that has made my patients’ life better – and my life easier – it has been cone beam technology, or 3D cat scans,” he says. “That combined with my CEREC CAD/CAM technology, procedures have gotten easier and less Michael Fulbright expensive, with better results.”

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Fulbright, in fact, had just completed an implant procedure shortly before taking time to discuss surgical advances that have changed the dental industry for the better. “With my Gallileos cone beam and CEREC, I was able to plan this morning’s surgery ahead of time and place the implant exactly where it needed to be using a surgical guide fabricated right in my office.” Not long ago, it would have been impossible to get an unobstructed view to determine whether the patient had enough bone height to avoid the mandibular nerve, he points out. Not so today.

“In the old days, using 2D X-ray technology, I would have to place implants freehand. Although I have placed many freehand implants successfully, the predictability and precision of guided implants has given us more confidence and has made the procedure

more efficient. The patient experience and case acceptance have increased dramatically with the patient being able to visualize and be a part of the planning process. With regard to our digital scanning technology (CEREC) to take impressions versus the old putty impressions, there really is no comparison. Patients love the fact that they don’t have to have a goopy, gaggy impression made, and the accuracy of the impression and fit of the subsequent crown is superior.”

“Today, I approach the procedure using reverse engineering, first planning the ideal crown and then planning the implant. Next, using a surgical guide sleeve over the missing tooth, I position the drill in the sleeve and can get within microns of the mandibular nerve or sinus, confident I won’t hit it.” Surgical times have been reduced from an hour to about 10 or 15 minutes, he adds. His practice runs more efficiently and his patients and dental team are happier.

Furthermore, even smaller dental offices are able to accommodate cone beam equipment. “The cone beam footprint is small enough that it should fit in most dental offices,” he says.

A window to the future If cone beam has changed the face of dental surgery, 3D printing has opened a window to the future. “3D printing definitely has changed – and will continue to improve – the way I work,” says Fulbright. “My CEREC digital scanner ensures I get the most accurate impression possible, which I can send to a lab or print a model in-office with my 3D printer. I believe this is where every dental practice is headed. I use my printer to print models for Invisaligntype aligners, sleep apnea appliances and nightguards.

“3D printers have come down in price tremendously,” he continues. And, because he is able to work more accurately and efficiently, his printer has practically paid for itself, he notes. “So, I don’t need to raise my fees to reflect the cost of the equipment. I don’t pass that cost on to my patients.”

3D printing is still relatively new, according to Fulbright. “It’s really just getting started,” he says. “Today, we only basically print plastic. As the materials catch up to the technology, I expect we’ll eventually move away from milling and start printing porcelain crowns and implant abutments. The sky is the limit.”

Expanding roles Advances in surgical technology have led to new and expanding roles for dental assistants. Indeed, as more and more can be accomplished in the dental office, dental assistants no longer take a back-seat to the rest of the team. “Dental assistants’ jobs have changed tremendously,” says Michael Fulbright, DDS, owner of Fulbright Cosmetic and Reconstructive Dentistry, Redondo Beach, California. “The dental assistants are the

ones who are learning the software involved in milling, planning and 3D printing. I always complete the training with my team, but it’s my dental assistants who are using these machines day in and day out!”

And this is a good thing, he adds. “Patients know and trust their dental assistants – often more so than their dentist. For patients, this technology means shorter chair times and less re-dos.”

Editor’s note: Michael Fulbright, DDS, owner of Fulbright Cosmetic and Reconstructive Dentistry (Redondo Beach, CA), offers restorative options such as dental implants and full-mouth rehabilitation, as well as a full range of general and cosmetic dentistry procedures. In addition, he is dedicated to helping individuals who suffer from obstructive sleep apnea. Dr. Fulbright is also very involved in giving back to his community. He has helped restore the lives of domestically abused men and women through the Give Back a Smile Foundation, as well as volunteered through Remote Area Medical (RAM), the Beacon House and various community causes.

ISSUE 2 • 2019 : DentalGroupPractice.com 31

Surgical Advances

Dental Implants Newer technology has made implants simpler and more accurate.

Dental implants date back to 2500 BC, when the ancient Egyptians tried to stabilize teeth with gold ligature wire. Today, researchers are exploring ways to grow a new tooth in a human adult – something that could take root, so to speak, in the next 10 years or so.

By Thomas Hirsch, DDS, the owner of a Malibu, California-based dental practice and founder of Isolite Systems, currently Zyris

Recently, a Tufts University team constructed a cellular matrix that allows successful implantation of a tooth bud into a pig’s jaw. Under their design, early adult-stage teeth develop within five months. Researchers project that humans won’t profit from these developments for another ten years.

The exciting progress hints at options once believed to be impossible.

For now, dental implants are the closest alternative to growing new teeth. Research has brought major benefits to implant technology as well.

A higher standard of care It was debated several years back that if dentists had a CT scanner in their office, they would be held to a higher standard of care. And, in fact, they were.

“Medical professionals who are liable for non-diagnosis of any abnormality on the 32

Efficiency In Group Practice : ISSUE 2 • 2019

CBCT scan include the dentist who orders the CBCT scan and likely any other professional who uses the CBCT for diagnosis or treatment planning. Dentists must possess the requisite standard of care when diagnosing and treating patients. This standard is normally stated as the level of knowledge, skill and care of a reasonable dentist. To meet this standard when using CBCT, dentists should use CBCT’s full capabilities to obtain maximum diagnostic accuracy. The standard of care must be met whether or not the dentist received specialized training on CBCT imaging because dentists are required to stay current in the areas in which they actively practice by enrolling in continuing education courses. There is even argument that dentists who use CBCT should be held to the higher standard of a board-certified oral and maxillofacial radiologist.”1 So how do dentists integrate a CBCT into their treatment planning and execution

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Surgical Advances

of dental implant procedures? Plan, plan, plan. It’s actually quite simple. First, patients should be medically evaluated before any implant surgery is scheduled. Patients either must have enough bone to support the implant, or be good candidates for surgery to build up the bone where the implant will be placed. Chronic illnesses, such as diabetes or leukemia, may interfere with healing after surgery. Patients that have taken bisphosphonates can have osteonecrosis of the surgical site. Using tobacco can also slow healing.

Another great advance, although it’s no longer considered new, is CAD/CAM technology. CAD/CAM, combined with CBCT technology, allows dentists to virtually plan the final result. So, the next step in this journey is to take physical or digital impressions of the patient’s maxillary and mandibular arches. Once the arches are scanned and the vital structures are identified (in this example, that includes the adjacent teeth and the mandibular nerve, as well as the mental foramen) a virtual final restoration can be designed.

With the proper size and shape of the final virtual restoration, the implant of choice can be positioned.

It’s vitally important to determine the path of insertion of the implant relative to the occlusal surface of the crown, lest the screw access hole exits out of the buccal or lingual! Now it’s clear where the implant should be placed, but how does the dentist ensure it gets there?

Neophytes in implant placement would do well to take beginning and advanced surgical dental implant courses.

But even the best laid plans can fall short when using steady hands to place implants in the genesis, which is why the surgical guide has become so important. Dentists can construct and print their own guide, mill it and have their laboratory fabricate one, or they can work with a third party. Whether the procedure involves a single implant or multiple implants, the surgical guide ensures it runs smoother, with fewer complications.

The surgery Now comes the fun part: the surgery. For this, dentists must trust in their planning and clinical abilities, since they cannot actually see under the patient’s bone, and proceed as follows: References:

• Review patient’s medical history.

• Review treatment, options, risks, complications, alternatives and fees.

• Verify surgical guide fit.

• Treat in accordance to surgical protocol.

• Lay a flap or go flapless (tissue punch).

• Place the implant.

• Place the cover screw or healing abutment.

• Close the surgical site.

At my dental office, the surgical time to place a simple implant, a healing abutment and to close the surgical site can be as short as 10 minutes. Much depends on the implant method selected. In the end, when the implant is placed with a high degree of precision and accuracy, it makes the final crown restoration a simple one.

Thanks to directly visible surgical conditions, implantation is not only safer, it’s also minimally invasive. What's more, dentists can save time during patient consultations since their patients understand the 3D visualization more easily.

Maximum efficiency All of this great CAD/CAM and CBCT technology has allowed me to design my operatories for maximum efficiency. We have placed treatment centers in all of our rooms. Our chairs are integrated with surgical motors built into the dental unit, and there is a pump for sterile saline. We always have a surgical handpiece ready to go.

It has become very convenient to remove a cover screw, healing cap, abutment or implant crown. Sure, this has involved an investment in technology, but the returns have been fantastic. My front desk assistant has been crossed-trained to determine how long the procedures will take and to schedule a shorter amount of time to accommodate them.

My hygienist can recommend treatment with a great deal of confidence, knowing that guided dental implant procedures are much easier for the patient and entire team, and my dental assistant essentially has an extra pair of hands during surgery. And as for me: dental surgery has become more like a hobby than work. I do it for the love of it.

1. Stuart J. Oberman, Esq. Dental Tribune U.S. Edition, Vol. 6 No. 18, December 2011.

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Efficiency In Group Practice : ISSUE 2 • 2019

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2019 OSAP Annual Conference

The Organization for Safety, Asepsis and Prevention (OSAP) – a community of clinicians, educators, policy makers, consultants and industry representatives who advocate for the Safest Dental Visit™ – will host its 2019 OSAP Annual Conference May 30 – June, 2, 2019 at the Westin La Paloma Resort and Spa in Tucson, Arizona.

Billed as the premier patient infection and patient safety education networking event, the conference will deliver the latest updates on evolving guidance and emerging infection prevention and safety issues.

Attendees will have the opportunity to customize their experience through multiple topic tracks, gaining valuable information, resources and products designed to help them better address infection prevention and safety challenges, as well as meet new colleagues who share their interest in this critically important topic area.

Leading up to the 2019 annual conference, OSAP has partnered with Indian Health Services (IHS) to offer an IHS-only dental infection prevention and safety program May 29-30. The private event will offer up to nine hours of CE credit. Preconference sessions will be available for educators and consultants to earn additional CE credits.

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Efficiency In Group Practice : ISSUE 2 • 2019

The 2019 OSAP Annual Conference is targeted to: • Educators.

• Infection control coordinators.

• Consultants and lecturers.

• Compliance officers of state dental boards.

• Risk managers.

• Policy makers.

• Sterilization technicians.

• Compliance officers of state dental boards.

• Hospitals and Federally Qualified Health Centers (FQHC) with dental clinics.

• Companies engaged in infection control and safety products and services.

After attending the conference, participants will be able to: • Describe current and emerging issues related to infection prevention and safety in oral healthcare settings.

• List new resources, tools and networks to optimize compliance.

• Identify important attributes to develop and enhance global leadership for the optimal delivery of infection prevention and safety.

Registration Space is limited so register online today! OSAP member registration fees apply to all membership levels above Basic.

You must log into your OSAP account to receive the member rate.

2019 OSAP Annual Conference May 30-June 2, 2019, Tucson, AZ Registration Open!

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$675

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$180

$260

Register today! https://www.osap.org/default.aspx Continuing dental education OSAP is an ADA Continuing Education Recognition Program (CERP) Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Participants requesting professional continuing education credits will receive a CE verification form to record the CE numbers for the specific courses they attend. To

receive continuing education credit, participants must sign in at the conference, attend the sessions, record the assigned CE number for each lecture attended (note: CE verification numbers are announced at the end of each session), and complete the required evaluation forms.

Attendees maintain their CE verification form as proof of participation in the educational programming.

For more information about the 2019 OSAP Annual Conference, email Office@OSAP.org or call +1 (410) 571-0003 | US & Canada: +1 (800) 298-6727.

Editor’s note: OSAP focuses on strategies to improve compliance with safe practices and on building a strong network of recognized infection control experts. The organization offers an online collection of resources, publications, FAQs, checklists and toolkits that help dental professionals deliver the Safest Dental Visit for their patients. Plus, online and live courses help advance the level of knowledge and skill for every member of the dental team. For additional information, visit www.osap.org.

ISSUE 2 • 2019 : DentalGroupPractice.com 37

Infection Control

Boot Camp 101!

Personal Protective Equipment

By Katherine Schrubbe, RDH, BS, M.Ed, PhD Dr. Katherine Schrubbe, RDH, BS, M.Ed, PhD, is an independent compliance consultant with expertise in OSHA, dental infection control, quality assurance and risk management.

She is an invited speaker for continuing education and training programs for local and national dental organizations, schools of dentistry and private dental groups. She has held positions in corporate as well as academic dentistry and continues to contribute to the scientific literature. Dr. Schrubbe can be reached at kathy@ schrubbecompliance.com.

38

Most of us associate the term boot camp with the military. It is described as a basic training that prepares recruits for all elements of service: physical, mental and emotional. It is also labeled as an intense experience that gives service members the basic tools necessary to perform the roles that will be asked of them. The purpose of this training is not to break recruits; in fact, the combination of physical training, field exercises and classroom time makes individuals strong and capable. It’s a tough process, but a rewarding one that many service members value for life.1 In dentistry, where there is a constant pursuit to provide patients with an infection free, safe dental visit, there exists another kind of boot camp. This one isn’t provided by the military, but rather by the dental industry’s Organization for Safety, Asepsis and Prevention (OSAP). This year’s Boot Camp, which took place in January, was themed, Safety Strong. Like military boot camp, it included three intense days of training designed to prepare new and existing dental team members responsible for infection control on the basic tools necessary to perform their roles. Although there was no formal physical training, each day began at 7:30 a.m. sharp and closed around 5 p.m., and included a full schedule of lectures and interactive field exercises, called “boots-on-the-ground” sessions.

Interestingly, the completion of OSAP Boot Camp has the same goal as military boot camp: to make dental team members strong and capable of carrying out OSHA standards and CDC best practices for infection control in their dental settings.

This year, I had the honor of being invited to speak at the OSAP Boot Camp conference. One of my assigned topic areas was personal protective equipment (PPE), and there were two objectives to my presentation: First, to define the elements and use of personal protective equipment (PPE) as required by OSHA and CDC recommendations that meet Standard Precautions. Second, to understand the rationale for compliance to

Efficiency In Group Practice : ISSUE 2 • 2019

standards, regulations, guidelines and best practices. PPE is sometimes an area of compliance that is taken for granted, so this may be a good time for a brief review and reminder on standards related to its importance and use.

Why comply with PPE? The Occupational Safety and Health Administration (OSHA) is part of the U.S. Department of Labor, and therefore a federal law. OSHA’s mission is to assure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.2 OSHA is there to protect workers from hazards on the job and in healthcare. Dental team members are exposed to a variety of such hazards, such as infectious agents from patients and contaminated equipment, as well as chemicals.

The use of PPE is mandated by OSHA with varying specifications. For dental healthcare workers, the Bloodborne Pathogens standard 1910.1030 clearly states, “when there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. Personal protective equipment will be considered appropriate only if it does not permit blood or other potentially infectious materials (OPIM) to pass through to or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used”.3 In dentistry, PPE act as an efficient barrier to prevent contact with infectious agents and hazardous chemicals.

Another OSHA standard – one which is sometimes overlooked in dental practices, but which must be carried out – is Standard 1910.132, Personal Protective Equipment.

It provides additional guidance on employer responsibilities and training related to PPE, stating that employers shall: • Provide PPE in appropriate sizes.

• Clean, launder and dispose of PPE. • Repair/replace PPE as needed.

• Ensure PPE is removed before leaving the work area.

• Train employees on proper use.4

Training Dental employers have a responsibility and obligation to train team members on PPE. During and after training sessions, there should always be time allotted for team members to ask questions and verify expectations. OSHA 1910.132 states that the employer shall provide training about: • When PPE is necessary.

• What types of PPE are necessary.

• How to properly don, doff, adjust and wear PPE. • The limitations of PPE. • The proper care, maintenance, useful life and disposal of the PPE.4 Also, the standard states that the team member shall demonstrate an understanding of the training and the ability to use PPE properly, before being allowed to perform work requiring the use of PPE.4 No dental team member should be permitted to perform duties with occupational exposure without being properly trained. If team members are not utilizing PPE appropriately, constructive corrections should be made immediately. OSHA 1910.132 states, “retrain when the employer has reason to believe that any employee who has already been trained does not have the understanding and skill required.”4 Dental team members should not be permitted to continue to act inappropriately, as it puts them at greater risk for occupational exposure and injury. Training should always be documented in writing to create a permanent record.

Although not a regulatory agency, the Centers for Disease Control and Prevention (CDC) provide key recommendations for PPE that are consistent with OSHA standards as indicated below. Guidelines from the CDC should be strictly followed to reduce the risk of disease transmission to both patients and dental team members.

Protective clothing Protective clothing, such as clinic gowns, can be reusable or disposable. They are used to protect the wearer from the spread of infection or illness should the wearer come in contact with potentially infectious liquid and solid material; gowns are considered one part of an infection-control strategy.5,6 OSHA requires long sleeves to protect forearms and clinic attire when spray/spatter of blood, saliva or OPIM is anticipated; also based on the information in 1910.1030, the desirable features of a clinic gown are tight cuffs, a high neck and fluid resistance.

ISSUE 2 • 2019 : DentalGroupPractice.com 39

Infection Control

Gowns must be changed when visibly soiled, at end of work-shift or whichever comes first, and team members must remove all PPE when leaving the treatment area.3 Therefore, gowns are not permitted in non-clinical areas, such as offices, food areas or outside. Often, there are team members who state they take their gown home to launder. This practice is strictly against OSHA; the standard states that laundering is the responsibility of the employer at the office or through contact with a commercial service. “Employees are not permitted to take contaminated gowns or lab coats home for laundering; when removed, they are to be placed in a designated area or container for storage, washing, decontamination or disposal.”3 If there are no laundering facilities on-site and

Key Recommendations for PERSONAL PROTECTIVE EQUIPMENT (PPE) in Dental Settings 1. P rovide sufficient and appropriate PPE and ensure it is accessible to DHCP. 2. E ducate all DHCP on proper selection and use of PPE. 3. Wear gloves whenever there is potential for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment. a. Do not wear the same pair of gloves for the care of more than one patient. b. Do not wash gloves. Gloves cannot be reused. c. Perform hand hygiene immediately after removing gloves.

4. W ear protective clothing that covers skin and personal clothing during procedures or activities where contact with blood, saliva, or OPIM is anticipated.

5. W ear mouth, nose and eye protection during procedures that are likely to generate splashes or spattering of blood or other body fluids.

6. R emove PPE before leaving the work area.

5. S ummary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care, 2016.

40

Efficiency In Group Practice : ISSUE 2 • 2019

no commercial contract for professional laundering, then disposable gowns should be utilized in the practice.

Face masks Face masks are a medical device labeled by the FDA and used to protect the mucous membranes of the nose and mouth from contact with sprays/spatter of oral fluids from the patient or items contaminated with patient fluid.5,7 Masks should be worn during any patient care activity, in the lab during grinding or polishing, when using chemical agents and during instrument reprocessing.3,5,7 As a strong reminder, face masks are single-use devices: one mask for each patient. The FDA labels face mask boxes with the universal symbol for a single-use item to ensure there is no question:8 Face masks also are made in a variety of protective levels, and testing is mandatory to determine which of these levels is provided by the American Society of Testing Materials (ASTM).9 The organization develops over 12,500 voluntary consensus standards, but for face masks, the current standard ASTM F2100-11 (2011) specifies the performance requirements for medical face masks with five basic criteria: • BFE (bacterial filtration efficiency). BFE measures how well the medical face mask filters out bacteria when challenged with a bacteria-containing aerosol. ASTM specifies testing with a droplet size of 3.0 microns containing Staph. Aureus. In order to be called a medical/surgical mask, a minimum 95 percent filtration rate is required. Moderate and high-protection masks must have bacterial filtration rates greater than 98 percent.

• PFE (particulate filtration efficiency). PFE measures how well a hospital mask filters sub-micron particles with the expectation that viruses will be filtered in a similar manner. The higher the percentage, the better the mask filtration. Although testing is available using a particle size from 0.1 to 5.0 microns, ASTM F2100-11 specifies that a particle size of 0.1 micron be used.

• Fluid resistance. Fluid resistance reflects the surgical mask’s ability to minimize the amount of fluid that could transfer from the outer layers to the inner layer as the result of a splash or spray. ASTM specifies testing with synthetic blood at pressures of 80 mm, 120 mm or 160 mm Hg to qualify for low, medium or high fluid resistance.

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• Delta P (pressure differential). Delta P measures the air flow resistance of the medical mask and is an objective measure of breathability. The Delta P is measured in units of mm H2O/cm2, and the lower the value the more breathable the mask feels. The ASTM standard requires that masks have a Delta P of less than 5.0 for moderate and high barrier masks, while low barrier masks must have a Delta P of less than 4.0.

• Flame spread. As healthcare facilities contain sources of oxygen, heat and fuel, the ASTM F2100-11 standards include testing for flame resistance. Testing dictates that all hospital masks must withstand exposure to a burning flame (within a specified distance) for three seconds.9

Boost case acceptance in every operatory

mask will suffice. Dental team members should check the information on the mask box to verify its protective level.

Eye protection Dental team members should wear eye protection with solid side shield to prevents ocular exposure and injury that may occur due to flying objects, spray/spatter of oral fluids and/or aerosols, and hazardous chemicals.3.5 Safety glasses or goggles must also comply with American National Standards Institute (ANSI) Z87.1-2010 to ensure a high level of impact resistancy.10 Every team member must be a part of the infection prevention and safety program and help each other remember to utilize eye protection.

Gloves In spite of the available guidelines, it can be difficult to determine which face mask will provide the best protection in dental settings. To assist the dental team, ASTM categorizes face mask by level.9 Given the possibility of a high amount of spray and spatter of oral fluids, team members should choose a face mask with higher filtration and fluid resistance; sometimes a Level 2 is adequate, however a Level 3 will provide the best protection. For tasks such as patient exams, lab work, taking impressions or operatory processing, a Level 1

Patient care gloves should be worn whenever there is the potential for contact with blood, saliva, mucous membranes, hazardous or infectious wastes or chemical agents.3,5,11,12 Patient care gloves are single-use items; they should always be donned on aseptically clean hands and inspected for tears or holes. They should never be washed or disinfected. In addition, it’s important that dental team members wear the correct size gloves and that they remove them before leaving the treatment area. Both patient care gloves and surgical gloves are regulated by the FDA, however, the non-medical ISSUE 2 • 2019 : DentalGroupPractice.com 41

Infection Control

ASTM F2100-11 (2011) REQUIREMENTS FOR MEDICAL FACE MASKS LEVEL 1 (LOW) BARRIER: 80 mm Hg

LEVEL 2 (MODERATE) BARRIER: 120 mm Hg

LEVEL 3 (HIGH) BARRIER: 160 mm Hg

BFE (Bacterial Filtration Efficiency) at 3.0 micron ASTM F2101

≥ 95%

≥ 98%

≥ 98%

PFE (Particulate Filtration Efficiency) at 0.1 micron ASTM F2299

≥ 95%

≥ 98%

≥ 98%

Delta P (Differntial Pressure) MIL-M-36954C, mm H2O/CM2

< 4.0

< 5.0

< 5.0

80

120

160

Class 1

Class 1

Class 1

Test

Fluid Resistance to Synthetic Blood ASTM 1862, mm Hg Flame Spread 16 CFR part 1610

ASTM F2100-11 (2011) REQUIREMENTS FOR MEDICAL FACE MASKS9 utility gloves are not.12 Utility gloves, which are punctureand chemical-resistant, should be worn when processing instruments and during housekeeping tasks that involve contact with blood, OPIM or chemical disinfectants.3,5,11 Utility gloves are available both as reusable and disposable. They are highly underutilized, but so very important for the protection of dental team members.

Personal protective equipment is mandated to protect the dental team at the workplace, and not meant to be overwhelming, inconvenient or difficult.

References:

Just like boot camp, this material was intended to provide a review of the basic elements and current information on PPE to prepare new and existing dental team members and those responsible for infection control to perform the roles that will be asked of them. Infection prevention is a team sport and requires team effort in each and every dental setting.

It is always a good idea to review the basics, but even a better idea to put them into practice and consistently exercise them.

1. Today’s Military. Boot camp. Available at https://www.todaysmilitary.com/training/boot-camp. Accessed February 2, 2019.

2. U.S. Department of Labor. Occupational Safety and Health Administration. Available at https://www.osha.gov/about.html. Accessed February 2, 2019.

3. U.S. Department of Labor. Occupational Safety and Health Administration. Available at https://www.osha.gov/pls/oshaweb/owadisp.show_ document?p_id=10051&p_table=STANDARDS. Accessed February 2, 2019.

4. U.S. Department of Labor. Occupational Safety and Health Administration.https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_ id=9777&p_table=STANDARDS. Accessed February 2, 2019.

5. Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care.

Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health, March 2016.

6. U.S. Food and Drug Administration. Medical gowns. Available at https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/ucm452775.htm. Accessed February 3, 2019.

7. U.S. Food and Drug Administration. Medical devices; Masks and N95 respirators. Available at https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/ucm055977.htm. Accessed February 3, 2019.

8. U.S. Food and Drug Administration. Medical devices; device labeling. Available at https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/Overview/DeviceLabeling/default.htm. Accessed February 3, 2019.

9. American Society for Testing and Materials. ASTM Mask Protection Standards & FAQ. Available at https://www.primed.ca/clinical-resources/astm-mask-protection-standards/. Accessed on February 3, 2019.

10. American National Standards Institute. Available at https://www.ansi.org/. Accessed February 3, 2019.

11. OSAP. OSHA and CDC Guidelines. Interact training system self-instructional workbook. 2017, section 3.

12. U.S. Food and Drug Administration. Medical devices; medical gloves. Available at https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/ucm056077.htm. Accessed February 3, 2019.

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Efficiency In Group Practice : ISSUE 2 • 2019

Hygiene

In Good Company

By Andrea Kowalczyk, RDH, BS Andrea Kowalczyk, RDH, BS, is the Lead Talent Acquisition Partner for a leading DSO. She has worked as a clinical hygienist, a hygiene mentor, consultant and speaker and publishes in several magazines, including First Impressions Magazine.

For more information visit AKowalczyk@amdpi.com.

44

Shedding light on practicing hygiene in corporate dentistry Two words: Corporate. Dentistry. What are the first thoughts that most hygienists associate with this? Are they warm and positive? Negative and skeptical? Confused?

For hygienists considering joining a dental service organization, what are some of their biggest concerns?

Oversight and protection Some of us assume that when a company employs a large staff it means those employees are an under-supervised lot left to their own untrained and detached whims.

Efficiency In Group Practice : ISSUE 2 â&#x20AC;˘ 2019

DSOs are generally large and highly visible. When groups are large, processes simply donâ&#x20AC;&#x2122;t fly under the radar as much. While every dental enterprise, whether one dentist or one thousand, must adhere to OSHA standards, not all

“Safety is our best marketing tool” “When we designed our office, we put a large window in our sterilizing room. People asked why we wanted patients to see dirty instruments. Easy – we want them to see how effectively we practice and trust that everything is completely sterile for their safety. And because it’s unique and cool, their word-of-mouth becomes our best marketing tool.”

Dr. Ileana T. Toro, DMD Dr. Junot J. Franco, DMD Village Park Advanced Cosmetic and Family Dental

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Hygiene

of them do. When companies are larger, they are a bigger and more visible target. The chances that they are OSHA compliant and then some increases. In my group, OSHA standards are religion, and we employ degreed, OSHA trained professionals who keep us compliant and lend support when we have questions. We all receive regular compliance training and are subject to frequent audits.

The misconception is that because a dental group is large, it must mean they are sloppy with the rules. In my experience, it is the opposite that’s true.

Diversity of thought The thinking is that the more moving pieces something has, more things can break or go wrong with it.

This might be true for washing machines, but not with groups of talented people. The more capable people a company employs, more things can go right. I am fortunate enough to work with literally hundreds of people who are smarter than me and have innovative ideas and unique perspectives and experiences. Where would we be without these beautifully diverse minds, all contributing to the same goal? We wouldn’t be as successful as we are. It is a fascinating thing to get to watch. It has made me a more well-rounded and open-minded person.

Like most hygienists, I enjoy my clinical colleagues. At the same time, it never fails to be a novel and fascinating experience to spend time with my team members from other disciplines, such as marketing, acquisitions, training and so on. For a hygienist, proximity to those individuals are limited at best in the private practice realm.

In my DSO, we have hygiene mentors, who essentially are realworld big sisters and brothers.

These more seasoned hygienists are there to answer clinical questions, talk over tough cases or offer encouragement.

Improved grievance resolution If an employee experiences discrimination or harassment, having an HR department to consult with is invaluable. If a hygienist should encounter disagreements with teammates that cannot be addressed within their practice, DSOs will often have multiple professionals on staff who can help resolve conflicts before they turn unpleasant or the hygienist feels compelled to resign.

Room to grow When you work as a hygienist in a small private office, your options for vertical career growth within the practice are limited. They amount to going to dental school or…well, that’s pretty much it. You could 46

Efficiency In Group Practice : ISSUE 2 • 2019

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become a lead hygienist, but your day-to-day job hasn’t fundamentally changed. What happens when you decide you want to stay in the hygiene space but can no longer treat patients due to injury, or you simply want to try something new?

In a corporate environment, opportunities for hygienists to grow and develop abound. I began at my corporate group as a clinical hygienist, became a hygiene mentor and now work as a recruiter. A friend of mine began as a hygienist, became a mentor and is now the operations director of his group. A hygienist colleague of mine is heading up a recruiting and credentialing department in our group. Another friend who began her early career as a hygienist is now one of our directors of operations. I also know a very talented person who began with us as a hygienist and is now our director of hygiene. These types of opportunities don’t exist in a private practice. While not everyone is looking to trade in their scalers for a briefcase, it is nice to know you have options should you choose to pursue them.

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Peer support When I was in hygiene school, we had a program called Big Sisters and Brothers. Second-year students were paired with a freshman student, the idea being that the student who was further along in the program could act as a mentor for the newbie. I adored my big sister. She sent me encouraging notes, lent me her study notes and met me for lunch to offer advice during that brutal freshman year. In my DSO, we have hygiene mentors, who essentially are real-world big sisters and brothers. These more seasoned hygienists are there to answer clinical questions, talk over tough cases or offer encouragement. When I began work as a clinical hygienist at my DSO, my mentor was my lifeline. Having this kind of support is critical for hygienists new to the field, and it’s a rarity.

Protocols I’ve never loved the term corporate dentistry because it implies that the dentistry being done is dictated by non-clinical corporations. It gives the false impression that the people directing treatment wear suits, not scrubs, ISSUE 2 • 2019 : DentalGroupPractice.com 47

Hygiene

and that it’s somehow different than the dentistry being done everywhere else. In the majority of cases, this is false. The dentistry performed in corporate offices is not mysterious.

In most cases, groups under the direction of dentists and hygienists will follow the recommended guidelines for treatment that we all learned in school and evolve when new evidence is released. If you have ever been encouraged to perform bloody prophies in a private office, you can appreciate how having some evidence-based clinical guidelines in place to guide your team would come in handy.

office closer to your new home that you can transfer into, or an office nearby that can accommodate your new schedule availability. You won’t lose your seniority or benefits. Plus, the learning curve will be a breeze.

Social opportunities

Security Not many small, private offices can afford to offer a full, generous benefit package to hygienists. Many DSOs can. I recently wrote about the perils of hygienists who depend on being able bodied. If they become injured or sick and can’t work for an extended period, they can be financially ruined. Having medical, retirement, life and disability insurance, accidental death and dismemberment, supplemental hospital coverage, etc.…can ensure you and your family are protected and won’t end up adrift should life throw you a curve ball. Benefits are more than a perk. They are a necessity for most of us.

Mobility Moving two hours or two states away? Do you have a new baby and need to reduce your hours? In the DSO world, you don’t necessarily have to quit your job and pound the pavement in search of a new one. Chances are, your group has an 48

Efficiency In Group Practice : ISSUE 2 • 2019

When companies are larger, they are a bigger and more visible target. The chances that they are OSHA compliant and then some increases.

In my group, OSHA standards are religion, and we employ degreed, OSHA trained professionals who keep us compliant and lend support when we have questions.

In a private office, it’s common to have no more than eight team members total. If you dislike three of them, you’re in trouble. In a large group setting, you have the benefit of having a large network of peers. It evens out if you aren’t keen on everyone. I can’t imagine my life without the kind, talented friends and mentors I have accumulated during my years with my DSO. Just like with private offices, opportunities exist for community service, practice team building, holiday celebrations and community involvement.

Ultimately, corporate dentistry is not for everyone. Neither is private practice. That’s what diversity and inclusion are about, and it’s healthy.

But, I encourage my hygiene friends not to shy away from corporate dentistry if they have been curious about it. Don’t hamstring your career based on unexplored options. Read patient and employee reviews online. Find a group that suits you, and you may surprise yourself when you thrive.

If one DSO is not to your taste, try another. Not all DSOs are created equal and each company culture is as varied as the people within it.

Who knows? You may find that corporate dentistry offers what has been missing in your career. If you are in search of opportunity, security and comradery, get a jump on the future and consider large group dentistry. Chances are, you’ll be in good company!

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News

Proof Positive

Burkhart’s Proven Solutions Center helps dental practices make the right equipment decisions.

Dental teams today have more and more solutions available to address patient care and practice management. That means finding new ways to integrate multiple devices, systems and software. For some practices, this is easier said than done.

Burkhart recognizes technology integration can sometimes be disruptive to the dental practice and recently created a digital equipment testing and evaluation center in its Tacoma, Washington corporate office called the Proven Solutions Center. In partnership with manufacturers, they test and evaluate digital dental equipment using key performance indicators. Helping their clients make more informed equipment purchase decisions – including the equipment’s ability to interface with other systems – gives them peace-of-mind, reduces their downtime and supports their success.

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Efficiency In Group Practice : ISSUE 2 • 2019

Solutions Center goals With the Proven Solutions Center, Burkhart accomplishes three goals: • Helps clients determine whether certain types of equipment integrate well with other equipment and/or software.

• Expands the knowledge and skills of Burkhart associates to be able to provide better client service.

• Works with manufacturers to develop a remote platform to resolve clients’ equipment issues in a more timely and cost-effective manner.

More informed decisions One of the many benefits the Proven Solutions Center offers is to provide clients with more informed product purchases. “The Proven Solutions Center

Certified Products Burkhart has partnered with a handful of manufacturers to test their equipment. Evaluation typically takes 3-6 months. Examples of manufacturers with products that have been certified include: Planmeca (Emerald Scanner and PlanMill 40 S), Kavo Kerr (OP300 Panoramic CBCT), 3M (True Definition Scanner), PreXion (3D Excelsior CBCT), and SciCan (Statim G4).

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One proven solution “My experience working with the Burkhart team at the Proven Solutions Center was nothing short of amazing,” says Keith Huang, vice president, operations, PreXion Inc. “As a manufacturer, we worked with the PSC to make sure our product met Burkhart’s expectations so there would be no surprises down the road for our future mutual customers.

“The whole process of getting our product to the PSC, setting it up, evaluating and testing with Burkhart was a breeze,” he says. “During the process, we learned what they liked and received suggestions as to what the market needs and wants. As a result, we were able to collaborate and work with Burkhart to make our product that much better and ready to launch.”

serves as a quality assurance function that supports our our clients, we have taken the Consumer Reports concept clients to ensure the quality and consistency of dental and applied it to our test center,” he says. “We have equipment we offer,” says Michael Norton, director of come up with report cards on various products and equipment and technology sales at Burkhart. “We expect how they perform.” this will make practices more efficient and profitable and No more costly downtime help doctors deliver a better patient experience,” he adds.

“We are excited to be working with manufacturers who “Over the last couple years, the Proven Solutions Cenare developing software and embedded sensors for their ter has tested, evaluated and supported the launch of new equipment to communicate and exchange data through technology products, as well as certified existing technology the internet,” says Norton. Burkhart solutions, to ensure our clients have sees the opportunity to eventually a positive practice experience with “To help our clients, we their technology purchase,” Norton have taken the Consumer serve clients remotely as the technology develops. “With this rapidly continues. Since its inception, the Reports concept and growing technology, we want to be Proven Solutions Center has tested applied it to our test able to better service equipment and evaluated digital equipment and center. We have come in a more predictable way for our technology for a variety of products up with report cards on clients. This will enable our service such as 3D cone beams, CAD/CAM various products and technicians to consistently show up systems, air compressors, sterilizers with the right part at the right time, and 3D printers. how they perform.” which will help our clients avoid “Not only do we test manufac– Shannon Bruil, director of costly and disruptive downtime.” turers’ equipment for our clients, technical services, Burkhart we also evaluate the equipment An exceptional client experience software and occasionally test how the software interOne of Burkhart’s goals is to consistently provide an faces with other third-party software,” says Chuck GreenExceptional Client Experience, which means consisfield, corporate service support manager at Burkhart. “We tently delivering service that is impactful and valuable to even determine what kind of support the manufacturers clients. They will continue to expand their reach by testing provide for a specific product. We call them with product and evaluating equipment and technology their clients questions because we want to make sure there is a good purchase to help them make more informed purchase decisupport structure in place for our clients.” sions that will ultimately support their continued success.

Burkhart’s director of technical services, Shannon Bruil, likens the Proven Solutions Center to providing a Editor’s note: Provided by Burkhart Dental Consumer Report-like service to dental clients. “To help 52

Efficiency In Group Practice : ISSUE 2 • 2019

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INDUSTRY NEWS Cantel’s Dental division acquires European-based Omnia Cantel Medical Corp. (NYSE:CMD), announced that it has completed its previously announced acquisition to acquire Omnia S.p.A., an Italian-based market leader in dental surgical consumable solutions. The portfolio infection prevention solutions of Cantel’s Dental division, Crosstex International Inc. will be further expanded to include Omnia’s wide-ranging portfolio of sutures, irrigation tubing and customized dental surgical procedure kits, with a focus on procedure room set-up and cross-contamination prevention. “Omnia’s comprehensive product lines of high-quality, innovative infection prevention and surgical solutions will be a strong addition to our growing dental portfolio,” said Gary Steinberg, President of Crosstex, Cantel’s Dental division. “We believe Omnia’s existing sales channels and focus on specialty dentistry will better equip us to service an additional segment of the dental market where maintaining aseptic procedures is critical.”

“We are very excited to join Cantel’s Dental division,” stated Robert Cerioli, new Managing Director for Cantel’s European Dental business (formerly President of Omnia) “As a part of the Cantel organization, we are better equipped to service the dental practices and expand the adoption of both the Omnia and Crosstex portfolios within the European markets.”

CVS partners with SmileDirectClub CVS Health is running a pilot with SmileDirectClub to fit people for the start-up's invisible braces in CVS' drugstores. In working with SmileDirectClub, CVS has added a so-called SmileShopExpress inside six of its drugstores.

There, people can get a 3D scan that will be used to create their invisible braces. This is a pilot program for now, the companies said. SmileDirectClub was already selling its kits inside retailers, including CVS and Macy's, but the pilot program could increase its exposure.

ADA supports legislation to extend funding for dental public health programs The American Dental Association (ADA) sent a letter of thanks to the Senate Committee on Health, Education, Labor and Pensions for introducing S 192, the Community and Public Health Programs Extension Act. The legislation 54

Efficiency In Group Practice : ISSUE 2 • 2019

was the focus of the committee’s Jan. 29 hearing and would extend funding for Community Health Centers, Teaching Health Centers and the National Health Service Corps through 2024. The ADA noted that the Health Resources and Services Administration supports the operation of nearly 1,400 health centers nationwide and community health centers serve as integrated health care homes for more than 28 million patients. According to the 2017 Uniform Data System, more than 15 million patient visited community health center dental programs.

Wallethub releases list of states with worst dental health Wallethub released its list of U.S. states with the best and worst dental health. The organization compared all 50 states and the District of Columbia across 26 key indicators of dental awareness. The data set ranges from share of adolescents who visited a dentist in the past year to dental treatment costs to share of adults with low life satisfaction due to oral condition. The 10 states with the worst dental health are: 51. Arkansas 50. Mississippi 49. West Virginia 48. Alabama 47. Louisiana 46. Alaska 45. Texas 44. Florida 43. Montana 42. California To see the full list, visit https://wallethub.com/edu/stateswith-best-worst-dental-health/31498/#main-findings

Florida considering options to combat dentist shortage Floridians for Dental Access, a new coalition seeking to rectify the shortage of dentists in Florida, has asked state lawmakers to sign off on a new healthcare license for dental therapists, who could perform a basic clinical dental treatment, preventive services, and other related services under the supervision of dentists. The Commission on Dental Accreditation adopted education standards for dental therapy programs in 2015, and several states have authorized dental therapists including Alaska, Arizona, Maine, Michigan, Minnesota and Vermont.

The initiative is not without controversy. The Florida Dental Association is opposed to the idea and as an alternative, is asking the Legislature to appropriate $500,000 to fund a forgiveness program for 10 dental students who would be willing to work in public-health settings or underserved areas.

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