Ready for prime time Hygienists today play a lead role in patient care.
MAY/JUNE : 2020 DENTALGROUPPRACTICE.COM
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Contents >
May/June : 2020
Publisher’s Note Teamwork guides industry response to COVID-19................................... 2
Relying on your SEO strategy in an uncertain time...........................4 Teledentistry: Is it viable in a hands-on business? Don’t expect it to mimic telemedicine........... 6
The game has changed............... 10 Cements Choosing the right cement is not a cut-and-dried decision.............................. 12
Composites Newer products have led to decreased placement time, with no compromise to quality and esthetics................................ 16
Selecting the right facemask The better the fit, the more likely it will be worn............................................... 18
Ready for prime time Hygienists today play a lead role in patient care............................. 20
Mobility & growth DSOs continue to present new opportunities for hygienists................. 23
Moving forward As doctors grow in their profession, so must dental assistants. DSOs provide the opportunities they need......................... 24
Dentists and their staffs take precaution before heading back to work
Strength in experience
The era of COVID-19 is unprecedented, from office closures to reopenings, and protection from the virus...................... 28
Standard operating procedures for infection prevention Uniformity, efficiency, productivity and competence........................................... 32
The dental assistant
Protecting the patient
With advances in technology, dental assistants must be prepared to play an instrumental role in the practice................. 26
Let patients know what and why you do the things you do to keep them healthy and safe..................... 36
EDITORIAL BOARD
A.J. Acierno, DDS, CEO, DecisionOne Dental Partners Kristine Berry, RDH, MSEC, NextLevel Practice Coach 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
EDITOR
Collaboration between team members drives quality patient care and continuous growth within the practice........................... 38
Dental industry disruption: A different dental context........ 41 Put your patients at ease.......... 44 Waste not, want not DSOs have the data. With artificial intelligence, they can put it to good use...... 46
News......................................................... 49 Infection prevention: All of the time.................................... 52
VICE PRESIDENT OF SALES Katie Educate keducate@sharemovingmedia.com
Laura Thill • lthill@sharemovingmedia.com
SENIOR EDITOR Graham Garrison • ggarrison@sharemovingmedia.com
MANAGING EDITOR Daniel Beaird • dbeaird@sharemovingmedia.com CIRCULATION Laura Gantert • lgantert@sharemovingmedia.com ART DIRECTOR Brent Cashman • bcashman@sharemovingmedia.com
PUBLISHER Scott Adams sadams@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 2020 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.
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Efficiency In Group Practice : ISSUE 3 • 2020
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> Publisher’s Note
Teamwork guides industry response to COVID-19
Scott Adams
With so much uncertainty in the world these days due to the COVID-19 pandemic, it is more important than ever for DSOs and dental providers to have outstanding staffs. Hygienists, dental assistants and office staff all play a vital role in making dental offices the best they can be. In “Ready for Prime Time,” Jennifer Rush, RDH, BSDH, director of dental hygiene at DecisionOne Dental Partners, talks about hygienists being clinicians, not just team members. Patients see their hygienist more than their dentist, so hygienists must be integral to a dentist office in every way, from keeping up with growing technology demands to knowing all of the office safety protocols, especially in today’s pandemic environment and a post-pandemic world. In our COVID-19 response article, the American Dental Association (ADA) and the Organization for Safety, Asepsis, and Prevention (OSAP) provide guidelines and toolkits for DSOs and dental providers returning to the office as states reopen their economies. The ADA’s Advisory Task Force on Dental Practice Recovery began meeting in April with the overall goal of helping dentists get back to serving their communities while protecting patients, office staff and themselves. The ADA’s “Return to Work Interim Guidance Toolkit” includes a comprehensive checklist for dentists to use while reopening their practices. To further help dental office staffs, OSAP has provided webinars on N95 masks and other respirators in dental settings, and proper steps for donning and doffing personal protective equipment (PPE). Meanwhile, Aspen Dental shares their procedures for welcoming back their patients amid the COVID-19 outbreak. As you reopen your offices or begin plans to reopen, please remember that Efficiency in Group Practice is here to provide you the insight into industry experts as well as how everyone is rallying back from mandatory isolation nationwide. We know you will follow the proper protocols in reopening, providing the utmost protection to your patients, your staff and yourselves. We welcome you back with open arms.
Hygienists, dental assistants and office staff all play a vital role in making dental offices the best they can be.
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> SEO
Relying on your SEO strategy in an uncertain time By Barry Nix
You have so much on your plate now. Our world has been turned upside down like never during our lifetimes. The COVID-19 outbreak shut down dental offices across the country. Now, many are considering when to return and how to return. But as states are trying to reopen their economies, dentistry has been identified by OSHA as a high-risk job for potentially contracting the new coronavirus.
So how do you handle it all? How can you reassure your staff and your patients that it’s safe to return? And how will your practice change under the new ADA guidelines for reopening? Where does your SEO strategy fit in during this uncertain time? The answer is simple: your SEO strategy can lead you to new heights as your office reopens. Dental groups that have been practicing strong SEO habits before are in prime position to capitalize on this new opportunity, and those who haven’t in the past can use this opportunity to start anew on their SEO strategy. With dental offices closing during the COVID-19 pandemic and many changing their business operations as they reopen, teledentistry has almost become a clinical necessity overnight. Many of these platforms can increase the impact of all scales of your oral health programs and some are waiving setup fees during this time of rebound. If your practice has onboarded teledentistry, it’s something that can draw in new patients and it must be promoted through your SEO channels.
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If your practice has onboarded teledentistry, it’s something that can draw in new patients and it must be promoted through your SEO channels. Make sure to keep your patients up to date on your website and social media feeds about your new office safety procedures and any new benefits your office offers them. Organic search is a zero-sum game. If you
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choose to withdraw your SEO campaign during this unusual time, your competition will jump to the front of the line. As the industry comes back, it will be more difficult to regain old patients and obtain new ones. So, engage with your patients. Communicate your updated office hours on your website and on any business listings. This is also a good time to audit your entire website to shed light on some of the current procedures you are focused on during this pandemic. Check your online reviews, answer them in a positive manner and update your office circumstances due to the pandemic. You may also want to refresh the look of your website and update your backlinks, which boosts your SEO results. Your social media feeds should be used to educate your patients and potential new ones on dentistry procedures during this tough time. What’s important for the patient to know and remember? This will identify you as a trusted and knowledgeable source that they can turn to for answers. It’s the perfect time to position your dental practice as a thought leader in the industry. New challenges bring new opportunities, and this is our biggest challenge yet. Be proactive with your marketing and SEO strategies, and let this challenge become the biggest opportunity of your career.
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> Executive Interview
Teledentistry: Is it viable in a hands-on business? Don’t expect it to mimic telemedicine.
Telemedicine is catching on among physicians. How about teledentistry? In February, the American Medical Association reported that physician adoption of televisits and virtual visits (including audio/video connections with patients) doubled, from 14 percent in 2016 to 28 percent in 2019. In addition, physician adoption of remote monitoring increased from 13 percent in 2016 to 22 percent in 2019.
On the other hand, it has been about two years since teledentistry codes – D9995 and D9996 – were added to the code set. But data on its usage is hard to come by. Chances are, teledentistry will take a very different course among dental practitioners than telemedicine has among physicians. Some of that is
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due to the nature of the beast(s). Dentistry is, after all, a hands-on business. But regulatory policy – and politics – is playing a role too. “There is a fundamental challenge with teledentistry compared to telemedicine,” says Eric Tobler, DMD, regional president, Stonehaven Dental in Northern Utah, and national
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director of clinical affairs for Mortenson Dental Partners. “In medicine, a large percentage of diagnoses can be entirely treated with medication.” That’s not the case in dentistry. “Most of what we do as dentists requires some physical treatment.” What’s more, today’s medical practitioners rely on technologies that remotely monitor and assess their patients’ blood sugar levels, heart rates and blood pressure, he points out. Similar technologies don’t exist in dentistry. But clinical and technological considerations are only part of the reason teledentistry faces a different future than telemedicine. “Many people see teledentistry as something that may work, but there are just as many obstacles,” says Dr. Tobler. The state dental board’s role is to protect the standard of care and promote safety and access to care within their states – not to drive innovation, he says. “Until teledentistry business models can answer questions about comprehensive care and diagnosis, I think they will struggle with state board approval.” A second challenge associated with state dental board approval is the fragmentation and inconsistency from state to state, he adds. State boards struggle to agree on “common sense” measures, such as a National Clinical Board Examination, he says. And “from state to state, we can’t agree on how to
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A definition of terms The term “teledentistry” refers to the delivery of patient care and education using, but not limited to, the following modalities: > Live video (synchronous): Live, two-way interaction between a person (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology. > Store-and-forward (asynchronous): Transmission of recorded health information (for example, radiographs, photographs, video, digital impressions and photomicrographs of patients) through a secure electronic communications
system to a practitioner, who uses the information to evaluate a patient’s condition or render a service outside of a real-time or live interaction. > Remote patient monitoring (RPM): Personal health and medical data collection from an individual in one location via electronic communication technologies, which is transmitted to a provider in a different location for use in care and related support of care. > Mobile health (mHealth): Health care and public health practice and education supported by mobile communication devices such as cell phones, tablet computers, and personal digital assistants (PDA).
Source: ADA Policy on Teledentistry, American Dental Association, 2015, www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-teledentistry
Patients’ rights Per the 2015 ADA Policy on Teledentistry, dental patients whose care is rendered or coordinated using teledentistry modalities have the right to expect: > That any dentist delivering services using teledentistry technologies will be licensed in the state where the patient receives services, or be providing these services as otherwise authorized by that state’s dental board. > Access to the licensure and board certification qualifications of the oral health care practitioner who is providing the care in advance of the visit. > That they will be informed about the identity of the providers collecting or evaluating their information or providing treatment, and of any costs they will be responsible for in advance of the delivery of services.
> That the provision of services using teledentistry technologies will be properly documented and the records and documentation collected will be provided to the patient upon their request. > That services provided using teledentistry technologies and methods include care coordination as a part of a dental home and that the patient’s records be made available to any entity that is serving as the patient’s dental home. > That the delivery of services using teledentistry technologies are performed in accordance with applicable laws and regulations addressing the privacy and security of patients’ private health information.
To see additional patients’ rights, see the 2015 ADA Policy on Teledentistry, www.ada.org/en/about-the-ada/ada-positionspolicies-and-statements/statement-on-teledentistry
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> Executive Interview
delineate responsibilities among dentists, hygienists and dental assistants. So, to expect national acceptance of something as nuanced and challenging as teledentistry is unreasonable in our current environment.”
Real-life applications Despite the roadblocks, some doctors are using basic teledentistry to treat patients in emergency situations or follow-up care, says Dr. Tobler. “When I am taking emergency calls, I always encourage patients to take a picture of their issue with a cellphone and send it to me. This often allows me to diagnose something quickly as either nothing to worry about or something serious that requires a face-to-face appointment. I also find it useful for doctor-todoctor communications.” Teledentistry can also play a role in cosmetic consultations, he adds. “A patient can send in pictures of their teeth and smile to give the provider a sense of what it would take to cosmetically fix their smile. The patient will then have a preliminary idea of what their price and treatment options are as they go into their face-to-face consultation. I see this as room for growth for teledentistry.” Under current circumstances, teledentistry may be problematic, he says. “However, in our ever-increasingly connected world, it is not unreasonable to think that additional opportunities will present themselves,” he says. “Teledentistry represents an opportunity to serve patients better and drive more patients to the practice. It also fosters relationship-building with the patient.”
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Putting a price on teledentistry Chances are, teledentistry will not have the same impact on the dental profession as telemedicine already has had on physicians. After all, pain can rarely be diagnosed without an appointment. And how many remote sites – such as homes – are equipped with intraoral cameras? That being the case, it’s no surprise that teledentistry isn’t top of mind for dental insurers. And that’s not likely to change anytime soon, says Mike Cole, vice president of insurance plan management for Dental Care Alliance.
honest, why we would use them,” he says. The codes may be useful if a practitioner in the field – e.g., a hygienist – calls in to the dentist. “At least, in that case, you have a clinician ‘examining’ the patient. But outreach is different than pure teledentistry, in my opinion.” Medicaid hasn’t proven to be much of a factor in teledentistry either, he says. “Medicaid is predominantly for children or those under the age of 21, and they need to be seen by a dentist for a comprehensive exam.
“If a teledentist bills for an exam and the patient comes to the office for a more thorough exam, the second one is not covered.” – Mike Cole, vice president of insurance plan management for Dental Care Alliance
“To dental insurers, teledentistry is simply an exam,” says Cole, who oversees a team of 16 people. “It’s very low cost and very easy to approve. However, there are limits on exams, and that’s the downside of teledentistry. If a teledentist bills for an exam and the patient comes to the office for a more thorough exam, the second one is not covered.” In 2017, the American Dental Association introduced two CDT codes for teledentistry – D9995 (synchronous) and D9996 (asynchronous). But the codes have had little impact on dental practitioners, says Cole. “We aren’t clear on when we would use these codes and, to be
“In my opinion, teledentistry is not the way to reach Medicaid patients. Mobile units and health departments are far more effective.” Cole, self-admittedly has “been around for a while,” including 21 years at DCA. “I’ve personally observed many changes in the industry. I do not believe teledentistry will ever be in a similar position as telemedicine. “Dentists receive calls from patients after hours, and the answer is always, ‘Please come in first thing in the morning so you can be seen,’” he says. “We know that, at a minimum, we’ll bill for a 0140 problem-focused exam and radiographs to diagnose the complaint. “That’s not going to change.”
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> Group Practice Consulting
The game has changed The great boxer Mike Tyson once said, “Everyone has a plan until they get punched in the mouth.” You thought you had it all figured out – growth plans, talent acquisitions and revenue targets. All you had to do was execute the strategy. And out of nowhere, you got punched in the mouth. And it wasn’t just you – we all got punched. Don’t act like you saw it coming. Now that it has happened, things will never be the same. So, what do we do?
Your game has changed. Imagine that it’s the World Series of Poker. You know your hand, and you have a good sense of the hand everyone else is holding because you are a pro and you know how this game is played. You know who is in the best position, and you know who is about to fold. Your plan is refined and it’s so good. All you must do is wait your turn. But out of nowhere, the dealer picks up his cards and reshuffles them. He informs everyone that it’s going to be a new game – a game that no one has played before. Everything you thought you knew about your status, your plan, your winnings and your place at the table, has changed. Now, it’s once again anybody’s game.
You can panic, or you can plan. The ones who panic are freaking out. They had one good plan, and now that it’s out the window, they are ready to fold their cards up and go home. The planners, on the other hand, are hard at work learning the nuances of the new game. How it’s played. How you win. What you can control. When we are stuck in panic mode, we can’t see the opportunities. But when we shift into planning mode, the opportunities begin to appear. Just because your original plan is dead, that doesn’t mean plan B, C or D won’t work. It’s time to finish the process of grieving your original plan and move onward and upward into your new reality. You can position your group to capitalize on the greatest talent redistribution in the history of our industry. But, the most fundamental topic relative to your success and the cornerstone for every outcome in your group practice will always be leadership.
‘You are what you eat’ is rule one of leadership in crisis. This isn’t dietary guidance – though my teams have often heckled me for my frequent dietary and biohacking experiments. While I believe that what we put in our mouths is critical
By Eric Roman, Founder, DSO Coach
to our ability to lead, in crisis we need to be most attuned to what we are consuming with our eyes and our ears. Right now, we’re consuming massive amounts of information through the media, news, peers, family members and neighbors. Even worse – we have instantaneous access to literally thousands of real time updates.
Ask yourself: What can I control? What are the things that you can do in your practice right now to create maximum positive outcomes? Moreover, how does the information that you are consuming affect your emotions, your perspective and your confidence? These events require our absolute greatest degree of leadership. You are a professional leader and your teams need you consuming only the information that is critical.
What happens now is up to you. Welcome to a brand-new game. My hope is that our industry responds through constant adaptation and innovation. This event can be the greatest opportunity of your life, if you make it so. Regardless of your cards, it’s a new game, and it’s anybody’s to win.
Eric Roman is an executive coach, strategic advisor and industry thought leader for dental management groups, software companies and high performers via DSOcoach.com.
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> Specialty Focus: Cements
Cements Choosing the right cement is not a cut-and-dried decision.
Features
Cements vary widely, from the materials they are comprised of to the features that define them and their applications. When clinicians understand the options available to them, they can select the most appropriate solutions for their practice.
Recent improvements in cement products – such as self-adhesives, which have advanced to the point where they reduce steps without sacrificing bond strength - have led to greater ease of use, efficiency, speed and performance, notes Russ Perlman, executive director of marketing, VOCO America, Inc. “A large DSO or group practice generally encounters a wide range of clinical situations,” he points out. As such, they need resin cements, glass ionomer cements and various types of temporary cement. “Many practices
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in this type of demographic don’t have the time to hand mix cement or wait for slower self-cure materials to set between patients,” he says. “Advancements such as QuickMix syringes, tack cure options, high-retention glass ionomers and self-adhesive resin cements reduce steps, decrease variables, save time and raise the clinic’s overall efficiency.” An understanding of the composition and formulation of cements is critical when deciding which type to use for different clinical situations, he adds.
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There are many features that differentiate cements within each category and sub category (permanent vs temporary; resin-based vs glass ionomer), according to Perlman. Often, choosing the best product depends on the application at hand, as well as clinician preference, he explains. Clinicians should consider a number of factors in making their decision, he points out, including: > Overall bond strength. > Film thickness. > Working and setting times. > How well it can be light-cured. > Substrate indications. > Fluoride release. > Number of steps required. In the case of adhesives, clinicians should consider, among other things, their ability to reduce or minimize post-op sensitivity. “Depending on the clinical situation, any one of the above features can be particularly important to the practitioner,” says Perlman. “For a highly esthetic focus, such as a veneer case, lower water solubility will help avoid staining or discoloration. For extremely busy practices, practitioners might appreciate a cement that requires fewer steps, such as a self-adhesive resin cement, or a cement that offers a tack cure, enabling them to work faster.” And, while practitioners appreciate speed, convenience and ease-of-use, above all, they value a
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> Specialty Focus: Cements
cement that offers maximum longterm bond strengths, he adds.
Meron Plus QM
Resin vs. glass ionomer The two most popular categories of permanent cements are resin cement (bonded-in vs. self-adhesive) and glass ionomer cements (pure glass ionomer (GI) cements vs. resin modified glass ionomer (RMGI) cements), according to Perlman. “The most obvious difference between resins and glass ionomers are their composition,” he explains. “Resin cements are composed of monomer-based resins mixed with glass fillers. Glass ionomer cements are composed of silicate glass powder mixed with polyacrylic acid; in some variations, such as RMGIs, they also include resin. “Resin cements generally have a higher bond strength than glass ionomer cements,” he continues. “Resin cements utilize mechanical retention to adhere to most, if not all, restorative materials (lithium disilicate, zirconia, etc.); there is no actual chemical bond between the restoration (crown, inlay, etc.) and the cement. Additionally, bonded-in resin cements must be applied with an appropriate resin-based adhesive system to successfully adhere to the tooth surface; the quality of the restoration’s adhesion value to the tooth is dependent on excellent physical properties from both the adhesive and the cement.” Comparatively, self-adhesive resin cements have adhesive added to the formula to eliminate the need for the separate bonding step, simplifying the procedure and minimizing headaches (e.g., post-op sensitivity) for both the practitioner and the patient.”
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VOCO is proud to present Meron Plus QM, a paste-to-paste resin-modified glass ionomer (RMGI) cement in a QuickMix syringe, formulated for strength, longevity and convenience. Meron Plus QM features nearly double the adhesion values of other popular brands, with a 5-to-10second tack-cure for quick and easy removal of excess material, representing a unique and powerful combination among paste-to-paste RMGI cements. This ensures a secure and reliable hold, even in unfavorable conditions, such as those encountered with short cores with a sub-gingival prep. The total two-minute working time offers sufficient time for the cementation of both individual restorations and bridges. Additionally, Meron Plus QM is self-adhesive, has a low film thickness for a precise marginal fit and continuous fluoride release, making it the perfect choice of cements with indications, including full crowns and orthodontic bands, as well as metal, ceramic and glass fiber-reinforced posts.
“Glass ionomer cements create natural chemical bonds,” Perlman explains. “In other words, they ionize with the tooth structure, and the exchange of ions between the tooth and the glass ionomer create a chemical seal with an inter-diffusion zone. The chemistry of glass ionomers facilitates the release of fluoride ions into the tooth structure. Additionally, glass ionomer cements are hydrophilic; even in the presence of moisture (e.g., saliva) they generate a chemical bond. By comparison, resin cements require isolation and can fail in the presence of moisture.” The clinical application dictates whether clinicians select a resin or a glass ionomer, notes Perlman. “For example, in the case of a short core when cementing a crown, a bonded-in resin cement
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might be the better choice due to its higher bond strength,” he points out. “When secondary caries underneath a crown are a possible problem, a glass ionomer cement might be the better option due to its fluoride release.” “With regard to temporary cements, two of the more popular categories are zinc oxide-based cements and composite (resin)-based cements,” he says. “Again, the decision when choosing between the two types is largely based on the clinical situation at hand and practitioner preference but there are tendencies to consider.” Resin-based temporary cements typically offer higher adhesion and esthetics compared to zinc oxide cements, while zinc oxide cements provide better relief of hypersensitivity and are typically not as difficult to remove.”
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Reduce the Cost of Handpiece Infection Control Compliance
ēsa brings your practice 100% compliance at 50% of the cost¹ Let’s simplify the CDC recommendations. If a semi-critical item (i.e., low speed handpiece) is heat-tolerant, it should be sterilized between patients. If it’s heat-sensitive, you should not use it: Instead, replace it with a heat-tolerant or disposable alternative.² Since replacement can be costly, talk to us about ēsa and the compliant, cost-effective ēsamate prophy system. ēsa disposable prophy angles fit the Midwest Shorty®, Rhino® and Star® Titan® handpieces.3 So, if you already own these handpieces, put an ēsa on them and be compliant wherever you work.
If not, consider our ēsamate ST and new ēsamate MW lube-free low speed handpieces. • Both are heat sterilization tolerant, 5,000 rpm, and backed by a 2-year warranty • Both offer proven air-driven performance; no recharging or batteries • Both are lightweight with a 360° swivel Best of all, both offer a simple, cost-effective solution to handpiece infection control compliance in all 50 states. To learn more, call us at 800-474-8681 or visit www.preventech.com
4330-C Matthews-Indian Trail Road • Indian Trail, NC 28079 • 800.474.8681 • 704.849.2416 • fax: 704.849.2417 • preventech.com 1 Cost comparison based on Henry Schein Dental website prices and promotions for ēsamate® and Nupro Freedom® Handpieces as of August, 2018. 2 “Summary of Infection Prevention Practices in Dental Settings,” Centers for Disease Control and Prevention, March, 2016. Page 14. 3 ēsa is available for Star Titan, Midwest Shorty and Rhino. All third party marks - ® and ™ - are the property of their respective owners.
> Specialty Focus: Composites
Composites Newer products have led to decreased placement time, with no compromise to quality and esthetics.
When it comes to dental restorations, there’s a lot riding on the composite. It takes a high-quality composite to successfully address shrinkage, polishability and handling. Yet many dentists tend to stick with their current composite until they encounter its shortcomings.
“When I ask dentists what their biggest concerns are with regard to composites, they almost always mention shrinkage, polishability, radiopacity and handling,” says Lisa Eisensmith, M.A., Senior Marketing Manager, Direct Restoratives, Ivoclar Vivadent, Inc. Shrinkage can affect the marginal integrity of the restoration; polishability can attribute to secondary caries; and radiopacity can aid in a diagnosis using an X-ray.
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In Eisensmith’s experience, dentists base their purchasing decisions primarily on how well the composite handles, which can be a very subjective decision, she points out. “They also look at promotions and price, peer recommendations and product evaluations,” she says. “Composites are a tough category due to the number of products on the market. And dentists do not tend to look for a new material unless they are experiencing challenges with their current
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: By Laura Thill
material, or if there is a significant advancement in materials.” While the composition of today’s composites – filler particles and monomers – is much the same as that of early composites, the size of the filler particles has significantly decreased, which has led to improved tooth strength, fracture toughness, surface hardness and overall tooth integrity. “The introduction of the nanosized filler particles almost 15 years ago has led to improved physical properties of the material, as well as the polishability and gloss retention of the restorations,” says Eisensmith. “The introduction of the 4mm composites also became a game changer
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for posterior composites. With regard to our 4mm composites at Ivoclar Vivadent, dentists can decrease placement time significantly without compromising the quality and esthetics of the posterior restorations.” Both the size of the filler particles and the pigments in the materials determine where the materials are placed, Eisensmith continues. “For example, many of the 4mm composites are indicated in the posterior. They have minimum shade offerings, which are more widely acceptable in Class I and Class II restorations. When it comes to the anterior, dentists tend to look for exact shade and transparency options so they can match the shade and characteristics of the natural surrounding dentition. Ivoclar Vivadent’s Empress Direct composite, for example, has 32 shades and 5 levels of translucency, which provides all the necessary options for a highly esthetic anterior restoration.” Over the past 10+ years, many dentists have made the shift from amalgam filling material to resin-based composites, according to Eisensmith. That said, patient demographics greatly impacts the choice of materials for direct fillings, she points out. “Amalgam fillings are still a relevant option for patients who do not wish to pay out-ofpocket costs for a direct filling,” she explains. “These are typically covered by dental insurance, while resin-based fillings often result in outof-pocket expense for the patient. “Esthetically pleasing resin-based filling materials are the more popular direct-filling material
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option,” she continues. “Approximately 80 percent of direct restorations are posterior restorations, which is why there has been a trend towards the more efficient 4mm posterior materials.” Composites – which have a shelf life between two and three years – can range in price, depending on a number of factors, according to Eisensmith. Flowable composites,
These materials have been validated by over five years of clinical studies and are known to facilitate efficiency in the dental practice, she notes. Dentists should consider the following: > What would I like to change about my current composite material? > What are the most important criteria I consider when choosing a composite?
“ The introduction of the nano-sized filler particles almost 15 years ago has led to improved physical properties of the material, as well as the polishability and gloss retention of the restorations.” – Lisa Eisensmith, M.A., Senior Marketing Manager, Direct Restoratives, Ivoclar Vivadent, Inc.
which are sold in a syringe delivery system with about 1.2 grams of materials, are considerably less expensive than sculptable composites in a cavifil delivery system with 4-5 grams. “The raw materials a manufacturer uses can impact on the price,” says Eisensmith. “Many times, pricing reflects the cost of raw materials, as well as the technological advancements of the materials. This can lead to a higher quality material designed to outlast the lower priced competitors.”
Points to consider Many dentists are still unaware of 4mm composites, even though they have been available for the past 10 years, according to Eisensmith.
“The objection I hear most often from dentists concerns how well the composite material handles,” says Eisensmith. “Dentists tend to have handling benchmarks based on the material they currently use. I understand how important handling is, but with the availability of composite warmers and new instrumentation that aids in a simplified placement, handling should not be a reason for dentists to walk away from a clinically proven, predictable material.” “The beauty of composites is that they are a consumable product for a procedure that is done quite frequently in every general practice,” says Eisensmith. They are a great foundation for success for both the dental practice and sales reps, she adds.
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> Hygiene
Selecting the right facemask The better the fit, the more likely it will be worn.
: By Laura Thill
There’s no skirting the importance of facemasks both during – and between – patient visits. Dental professionals face constant exposure to microorganisms from dental unit waterlines and bioaerosols, which are generated by dynamic dental instruments. Splash, splatter and submicron aerosols continue to be a source of potential infection. And, because submicron particles are known to stay airborne for up to 30 minutes following an ultrasonic scaling procedure, the risk does not end once the procedure is over or the patient leaves the treatment room.
“Based on a 2004 classic literature review of aerosols and splatter by Harrel and Molinari, ultrasonic scaling has been shown to produce the greatest amount of aerosol and splatter contamination due to the composition of particles of varying size, which range from 0.001 to 100 μ,” says Leann Keefer, RDH, MSM, director, clinical services & education, Crosstex International, now a proud member of HuFriedy Group. “The smaller the size, the greater the potential it will be inhaled and penetrate and lodge in the lungs, which is thought to carry the greatest potential for transmitting infections. Additionally, because these submicron particles stay airborne for extended periods, dental clinicians and team members must opt to don/ wear, at a minimum, a Level 1 mask between patients when they are turning/cleaning the treatment room.”
A mask for every task Facemasks have seen improvements in recent years with regard to fit and efficiency. And while some masks may look similar, each brand or design
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offers unique characteristics, which affect its level of protection, notes Keefer. Selecting the right masks for a dental practice depends on the types of procedures for which they’ll be used. For instance, an ASTM Level 3 mask is recommended for procedures such as ultrasonic scaling or air-polishing, which produce moderate-toheavy amounts of fluid, spray and/or aerosols, according to Keefer. (See the table: ASTM levels) “Manufacturers who use quality sourced materials often choose to submit their products for voluntary ASTM testing,” says Keefer. “ASTM International is a standards organization, as well as a globally recognized leader in the development, product testing and delivery of international voluntary consensus standards. An ASTM specification determines the
ASTM* Levels ASTM Level 1
ASTM Level 2
ASTM Level 3
Ideal for procedures where low amounts of fluid, spray and/ or aerosols are produced. • Patient exams • Operatory cleaning and maintenance • Impressions • Lab trimming, finishing, and polishing • Orthodontics
Ideal for procedures where light-to-moderate amounts of fluid, spray and/or aerosols are produced. • Limited oral surgery • Endodontics • Prophylaxis • Restorative/composites • Sealants
Ideal for procedures where moderate-to-heavy amounts of fluid, spray, and/ or aerosols are produced. • Complex oral surgery • Crown preparation • Implant placement • Periodontal surgery • Use of ultrasonic scalers (magnetostrictive and piezo) • Laser-based applications
*ASTM Intemational is an international standards organization, as well as a globally recognized leader in the development, product testing, and delivery of international voluntary consensus standards. The latest version of the standard specifying performance of face masks, ASTM F2100- 11, was released in April 2011. Face mask material performances is based on testing for fluid resistance, bacterial filtration efficiency (BFE), particulate filtration efficiency (PFE), breathability, and flammability.
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classification of medical face mask material performance, based on its fluid resistance, bacterial filtration efficiency, differential pressure (breathability), sub-micron particulate filtration efficiency and flammability. Clinicians use the ASTM F-2100-11 performance standard chart to select the correct level of mask for the task based on the amount and type of bioaerosols generated, as well as the length and time of the procedure.” When clinicians understand ASTM levels, they can make informed choices that ensure maximum protection and help minimize the spread of potentially infection bioaerosols, she adds. “Additionally, it is important to understand that each layer of the mask has a specific function,” says Keefer. The outer layer facing the patient is designed to resist fluid, while the inner layer is designed to offer comfortable contact with the clinician’s face, she explains. The middle layer is designed to address the level of filtration. “The thickness or weight of the middle layer impacts the filtration efficiency; typically, this layer weighs anywhere from 18 to 33 grams per square meter (gsm).” However, clinicians do not always get what they pay for, she notes. “Some clinicians have cut their masks in half, only to discover they are constructed with only two layers, and the masks will not be as effective as expected.”
Fit, fogging and allergies The more comfortable the mask is, the more likely people will wear it, notes Keefer. “Is the mask material soft against the skin? Are the ear
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loops attached to the outer portion of the mask? Is there a breathing pocket? If so, there is a higher chance that the mask will be worn properly,” she says. Some wearers may twist the ear loops into a figure eight for a closer, more comfortable fit, she adds. However, by doing so, the inner lining of the mask material inevitably will touch the lips and nose, leading to contact moisture and wicking from breathing and talking, which may result in cross-contamination and/or the risk of disease transmission.
adaptation of the malleable nose strip is critical; this will also help reduce fogging of eyewear and loupes. “Prior to placing the mask to the face, the wearer should create a slight concave divot by gently pressing their thumb against their first two fingers along the aluminum noseband,” she continues. “This will act as a guide for proper placement high on the bridge of the nose and secure a loop around each ear. The wearer should mold the nosepiece with the index and middle fingers for a secure fit around the nose and along the orbits of the eyes, and
“ It is important to understand that each layer of the mask has a specific function.” Leann Keefer, RDH, MSM, Director, Clinical Services & Education
“Some clinicians may have very sensitive skin and the repeated exposure to daily mask wear can result in contact dermatitis, a red, itchy rash caused by direct contact with a substance or an allergic reaction to it,” she points out. “Often, this will occur in reaction to the type of paper/tissue liner of the mask or any chemicals or dyes used during manufacturing.” In this case, it’s wise to opt for a hypoallergenic mask with a soft white hypoallergenic inner cellulose layer, which is free of chemicals, inks and dyes, she explains. “Appropriate donning of the mask influences the fit and effectiveness,” says Keefer. “Since the highest area of bioaerosols contamination on the clinician’s face is between the eyes and the bridge of the nose,
always ensure the pleats of the mask material are facing downward to prevent pooling of condensate or aerosols within the mask, which could result in wicking and contamination exposure. Some manufacturers offer a fog-free design feature, which includes an additional absorbent strip of breathable fabric on the inner layer attached along the top to trap condensation from clinician’s breath.” In spite of the health risks associated with not wearing a facemask or selecting one with the appropriate fit characteristics, some dental professionals remain noncompliant, notes Keefer. “Knowing the standards, sharing the clinical why with colleagues and selecting the right mask for the task will ensure best practices in personal protective equipment.”
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Ready for prime time Hygienists today play a lead role in patient care. Advances in technology have opened a host of opportunities for dental hygienists in recent years. Particularly for those working in a large group practice or dental service organization, where the cost of new technology is less prohibitive than it is for solo offices, hygienists can – and often are expected to – play an increasingly greater role in patient care.
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> Hygienists
Indeed, many hygienists today are a significant part of the dental team, according to Jennifer Rush, RDH, BSDH, director of dental hygiene, DecisionOne Dental Partners. “At DecisionOne Dental Partners we look at the hygienist not just as a team member, but as a clinician,” she says. “We value the hygienist like we value a doctor. In addition to providing outstanding customer service, our hygienists provide care to their patients; they are taught to look at their patients’ systemic health, not just their oral health. “Our patients see more of their hygienists than any other healthcare provider,” she continues. As such, they make it a point to educate their patients and form long lasting relationships with them. “For example, we all take blood pressure readings on all our patients, at every visit,” she says. As a hygienist, I am more likely to catch high blood pressure than their regular physician is. It’s a great feeling to know I am directly involved in improving my patients’ overall life.”
The role of technology Rush credits advances in technology for helping hygienists expand their role in recent years. For that reason, hygienists must stay current on the latest and greatest products in order to provide the best possible care, she adds. “Hygienists must constantly grow in their profession,” she points out. “As a primary healthcare provider, hygienists must keep current on new technology, together with doctors,” she explains. As she discovered after joining DecisionOne Dental Partners, the closer in
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touch she is with new services and technology, the better able she is to develop her skills and care for her patients. Hygienists who keep current tend to be more involved in treatment plans and post-operative procedures, leading to better communication and improved patient compliance, notes Rush. “In addition, DecisionOne Dental Partners has gone almost completely paperless, enabling the whole dental team to access patient records more quickly and provide more thorough, efficient care,” she says. And, thanks to such products as VELscope and OrallD, the DecisionOne team including their hygienists - can spot health risks that previously went unseen. “Technologies such as these help us see things we were unable to see with our naked eyes,” she says. “This is a great thing for patients, as we are catching abnormalities at earlier stages.”
Association, Rush points out, noting she appreciates that DecisionOne Dental Partners encourages all of its team members to do so. Long gone are the days when hygiene care was limited to flossing and polishing patients’ teeth, notes Rush. “Today, patients are more educated about their oral health and expect more from their hygienists,” she says. “Hygienists are responsible for their patients’ overall health.”
In sync Growing concern around infection control and the importance of following safety protocols in dental offices may lead some to question how realistic it is for hygienists in a DSO setting to meet a consistent standard of care. However, an educated, conscientious dental team can do so, according to Rush. “When you are following the standard of care and proper protocols set up by the American Dental Hygienists’
“ Now more than ever, hygienists need to be on top of new products, technology and research in order to help educate patients and improve their lives.” – Jennifer Rush, RDH, BSDH, Director of Dental Hygiene, DecisionOne Dental Partners
The challenge for hygienists is to take it upon themselves to continually learn about new technological advances and scientific research that can lead to better patient care. Now more than ever, hygienists need to take advantage of continuing education and resources offered by such groups as the American Dental Hygienists’
Association, the American Academy of Periodontology, state dental boards and so forth, it doesn’t matter how large the practice is or where the offices are located; you know the patients are getting the best possible care,” she says. “Not only am I a chairside hygienist, but also the hygiene director for DecisionOne Dental
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> Hygienists
Partners. One of my main roles is to coach and mentor over 80 hygienists in our group and see that the highest standard of care is maintained at all of our dental offices to ensure the safety of our patients. “DecisionOne Dental Partners was founded – and is run – by two working dentists,” says Rush. “They know how important it is for all of our offices to be up to date on training and education. All team members,
including administrative personnel, receive in-person OSHA/HIPAA training, as well as online webinar training. We also have infection prevention quality control measurements through the use of team member evaluations.” Hygienists are encouraged to be role models in infection control and adhering to safety protocols, she adds. As patients become more aware of oral-systemic connections, they
likely will seek out more frequent dental care, according to Rush. In addition, the growth of DSOs is making dental care more affordable and accessible, she points out. Changes such as these are making hygienists more valuable to the dental team than ever before, she notes. “Now more than ever, hygienists need to be on top of new products, technology and research in order to help educate patients and improve
“At DecisionOne Dental Partners we look at the hygienist not just as a team member, but as a clinician.” – Jennifer Rush, RDH, BSDH, Director of Dental Hygiene, DecisionOne Dental Partners
their lives,” she says. “In group practices, there is a certain standard of care that’s expected, measured and encouraged; if hygienists are not growing in that regard, they can fall behind the times. “At DecisionOne Dental Partners, we believe in changing dentistry to improve lives,” she continues. “Hygienists at DecisionOne Dental Partners are the first line of clinicians who make sure this happens. I am proud of my profession and equally proud of what my group is doing for our patients.”
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Mobility & growth DSOs continue to present new opportunities for hygienists.
The dental industry has been a hub of growth these past couple of decades. Shaped by new diagnostic tools and therapies, as well as the growth of dental service organizations, dentistry places more and more demands on clinicians – hygienists included. Once considered the masters of pick and polish, hygienists have kept pace with these changes, taking on more and more responsibility, while taking advantage of efficiencies afforded by new and better technology.
“Today, we have so many new diagnostic tools, therapies and knowledge at our disposal that we didn’t have 10 or 20 years ago,” says Andrea Kowalczyk, RDH, BS, lead talent acquisition partner for a leading DSO. “While we have taken on more responsibility as we’ve adopted these new technologies, some of these tools have enabled us to save time and effort.” Successful hygienists must be trained on such technologies as laser, intra-oral cameras and digital diagnostic tools, she points out. In many cases, hygienists have moved to DSOs, which support the training and education necessary to adopt new technology, she says. But, even when the move has been less than intentional – for instance, when private practices are sold to DSOs – the transition can be positive for hygienists who are open to change.
Resources and education In Kowalczyk’s experience, hygienists working in a DSO setting have career-building opportunities that those in the private sector sometimes lack. “DSO’s often have access
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Andrea Kowalczyk
“Our hygiene trainers and mentors, as well as other professionals, ensure all of our hygienists follow clinical guidelines in order to provide great and safe care.” – Andrea Kowalczyk, RDH, BS, lead talent acquisition partner for a leading DSO
to resources and new product education, which a smaller practice may not have,” she explains. “Some DSOs use proprietary software, which has been created especially for them and often is more robust to software available to private offices. “Within some of our groups, hygiene committees have been created that include clinical hygienists who treat patients with new products and therapies, and then evaluate them for future use,” Kowalczyk continues. “It’s a great way to be involved.” Furthermore, DSOs emphasize infection control throughout the organization, she notes. “Many of our groups employ quality assurance officers who ensure the entire dental team complies with OSHA guidelines,” she says. “Since those guidelines are always evolving, we rely on these officers to keep us abreast of important changes. Our hygiene trainers and mentors, as well as other professionals, ensure all of our hygienists follow clinical guidelines in order to provide great and safe care.” Because hygienists employed by DSOs have an opportunity to work with so many professionals, including recruiters, marketing specialists, infection control specialists, etc., they often go on to fill these positions at their organization, Kowalczyk points out. These are opportunities they may miss out on in private practices, she adds.
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> Dental Assistants
Moving forward As doctors grow in their profession, so must dental assistants. DSOs provide the opportunities they need.
: By Laura Thill
vacation, I can always find someone from another DecisionOne Dental Partners office to fill in for me.” As a result, the practice rarely needs to rely on a temp service, she explains, not to mention it’s an opportunity for those looking to add extra hours. Dental assistants working in DSOs also benefit from growth opportunities they may not have in a private practice, she continues. “I have been a dental assistant for 18 years,” she says. “For the last three years, in addition to chairside assisting, I have taken on the role of dental assistant coach and I’m the OSHA representative for our DSO. As such, I help train and onboard all new assistants, as well as ensure our practices are OSHA compliant.” And, she’s confident she’ll continue to grow professionally in years to come.
New technology, new responsibilities Working in a dental service organization (DSO) comes with its share of opportunities, according to Nina Diasio, a dental assistant coach and OSHA/ HIPAA compliance officer at Chicago, IL-based Acierno Family Dentistry, a DecisionOne Dental Partners supported practice. At the same time, given how quickly DSOs adopt new technology, dental assistants today must be fast learners, she adds.
Dental assistants today continue to be indispensable to the dentist, whether they work in a private practice or a DSO, notes Diasio. “However, there are many more opportunities
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in a DSO situation,” she says. For instance, it’s much easier to find a replacement in a DSO setting when scheduling vacation or sick time, she points out. “If I want to schedule a
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DSOs are well-positioned to adopt new technology, which means better patient care. Dental professionals today can catch and treat more oral health issues than ever before, Diasio points out. “As a result, our patients are healthier and can keep their teeth longer,” she says. “The challenge for the dental team, however, is that we must stay on our A-game at all times, whether that means keeping up with technology or being able to properly educate patients. Technology has become a much greater part of our
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job, and we need to move quickly to keep up with it.” Indeed, dental assistants today have a whole new and sophisticated set of responsibilities. “Not only are we now seeing more patients and doing a lot more dentistry, but the new materials and technology are very technique sensitive,” says Diasio. We are expected to learn and do a lot more than we did 10 years ago. “For instance, our offices have started to use laser therapy for periodontal treatment. The lasers are very technique sensitive and the care for the lasers is very particular. Even though dental assistants don’t use the laser equipment, we need to learn everything about the procedure and the equipment in order to educate the patients and properly care for the equipment. “Ten years ago, there weren’t digital scanners,” she continues. “Doctors weren’t doing as much Invisalign or placing implants. Today, it’s vital for dental assistants to be able to take a great digital impression. As the doctors grow in their profession, we have to move right along with them.” Dental assistants who are not willing to learn new techniques and adapt to new technology won’t go far in their profession, she adds.
The same but different While protocols are in place at DecisionOne Dental Partners to ensure a degree of consistency, each office is unique, according to Diasio. “We insist that every office follows the same standard of patient care and comply with OSHA standards,” she explains. “It’s important that
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A higher standard As OSHA guidelines become stricter, dental assistants are held to higher infection prevention standards, according to Nina Diasio, a dental assistant coach and OSHA/HIPAA compliance officer at Chicago, IL-based Acierno Family Dentistry, a DecisionOne Dental Partners supported practice. Dental assistants today must incorporate more and more infection prevention and control protocols into their daily routine, she points out. “Complying with OSHA is a huge priority for all of our offices at DecisionOne Dental Partners,” she says. “We hire a third party to come in and make sure we are up to date on OSHA and HIPAA standards, as well as provide us with the necessary training to help us keep up with these new protocols. Bloodborne pathogens can exist in any dental office, she continues. “We must ensure we protect the office team and our patients, each and every moment. OSHA is here to protect us; its standards and protocols are constantly changing and we have to make sure we stay current.”
“Technology has become a much greater part of our job, and we need to move quickly to keep up with it.” – Nina Diasio, a Dental Assistant Coach and OSHA/HIPAA Compliance Officer at Chicago, IL-based Acierno Family Dentistry, a DecisionOne Dental Partners supported practice.
patients can have a great experience at any of our offices. However, the doctors at DecisionOne Dental Partners are given a good amount of autonomy with regard to how they run their office. As such, the dental assistants in our group only need to be in sync with their office. My job as the dental assistant coach
is to visit all of the offices in the DSO and make sure the assistants are comfortable and enjoy their job, and answer any questions they may have about the systems or protocols in place at their office.” Diasio anticipates the patient experience will become increasingly more important in years to come, further impacting the role of dental assistants. “Patients are always looking for a better experience, whether it is at the front desk or in regards to their health,” she says, and the dental team will continue looking for ways to deliver the best possible service. For dental assistants, this will mean continuing to evolve with the profession and staying current with the latest techniques and technology. “Dental assistants will be more important in years to come than ever before,” she says.
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> Support Staff: Dental Assistants
The dental assistant With advances in technology, dental assistants must be prepared to play an instrumental role in the practice.
Continual advances in technology and a growing focus on improving the patient experience and achieving best possible outcomes has impacted the role of dental assistants. “Dental assistants today require a much broader base of knowledge than in the past,” says Tim Whitaker, DMD, Marquee Dental Partners. Not only must they understand different materials
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and how they interact with other substances, they need advanced knowledge and training to stay on top of new technology, he points out. “Regardless of whether they are working in a stand-alone practice or a dental service organization (DSO), dental assistants have three key responsibilities,” says Whitaker. “First, their job is to provide a clear working
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: By Laura Thill
field for the dentist in a timely manner, with minimum discomfort to patients and resulting in a quality restoration. Second, they must educate and relax patients by explaining the treatment that’s to be provided, as well the value of additional treatments needed. Third, dental assistants must be instrumental in providing a safe, clean environment for patients.”
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Mastering new technology Patient care has been – and continues to be – a top priority for the entire dental team, dental assistants included. But technologies such as digital X-ray, chairside printing and 3D milling require specialized knowledge and education., particularly as the methods and equipment frequently change, according to Whitaker. “Mastering new technologies and techniques requires advanced training, including both classroom and hands-on training,” he says. While this may eat into the time dental professionals can spend chairside, continuing education is a must, not an option, he adds. Once new technology and techniques are mastered, the dental team can work more efficiently, resulting in greater office productivity, decreased chair time, better patient results and less stress for both patients and staff, he points out.
well as commonly prescribed medications, over-the-counter drugs and supplements,” he continues. “They also need computer skills for using dental practice management software to enter treatment notes and plans for future treatment. “Dental assistants must have a clear understanding of the processes required for disinfection and sterilization, and be able to prepare the room and equipment in accordance with correct sterilization processes, in order to provide a safe and clean
notes Whitaker. “In solo practices, the dental assistant can simply talk to the dentist and together they can decide on materials, quantities and the best time to place an order,” he says. “In a DSO, there are firm budgets with specific formularies, making coordination and communication among offices especially important. “A decade ago, we could not have predicted the technology and treatment innovations that have reshaped the role of the dental assistant,” says Whitaker. “Mastering these advances
“ Dental assistants today work with much more technically advanced equipment, which assistants could not even imagine 10 years ago. As a result, they must be more highly educated and involved than ever before.” – Tim Whitaker, DMD, Marquee Dental Partners
Greater demands That dental assistants today are asked to work with more sophisticated technology and play a bigger role in the operatory is a testimony to their value to the industry. But greater responsibility means more and better training to prepare for the position. “Dental assistants today work with much more technically advanced equipment, which assistants could not even imagine 10 years ago,” says Whitaker. “As a result, they must be more highly educated and involved than ever before. “It’s particularly helpful for dental assistants to have a basic understanding of drugs used in the dental office for local anesthesia and sedation, as
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environment for the patient,” he explains. In addition, they must be able to read and understand equipment manuals in order to follow complex and ever-changing infection prevention protocols. In multiple site group practices and DSOs, dental assistants must adhere to consistent standards and protocols, Whitaker points out. “In order to ensure efficiency, it is important to have standard, consistent protocols within the multiple offices of a DSO,” he says. “This can be achieved by companywide training.” It’s also important for dental assistants in DSOs to maintain consistency when ordering supplies,
will continue to require additional training and an investment in materials – both in school and through continuing education. “Regardless of what changes in technology occur in the future, the dental assistant will continue to play an instrumental role in the dental practice, ensuring patients are comfortable, educated and safe,” he says. Moving forward, dental assistants will play a greater and greater role in helping dentists be more productive and effective, he notes. “As such, there will always be a demand for welltrained, proficient dental assistants, and I believe that need will continue to grow in the years ahead.”
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> COVID-19 Responses
Dentists and their staffs take precaution before heading back to work The era of COVID-19 is unprecedented, from office closures to reopenings, and protection from the virus.
The COVID-19 outbreak and its impact on our daily lives is rapidly evolving. As dentists and their staff entertain going back to work after states reopen, they have been identified as a high-risk job for potentially contracting the novel coronavirus. In that realm, the American Dental Association (ADA) has provided mask and face shield guidelines and a return to work toolkit that are meant to help practices take measures before, during and after patient appointments to protect dentists, patients and staff. In a statement, the ADA said it believes dentists should exercise professional judgement and carefully consider the availability of appropriate personal protective equipment (PPE) to minimize risk of coronavirus transmission.
According to OSHA, dentistry work tasks associated with exposure risk levels include: > Lower (caution) > High > Performing administrative > Entering a known or suspected duties in non-public areas of COVID-19 patient’s room or dentistry facilities, away from care area. > Providing emergency dental care, other staff members. > Medium not involving aerosol-generating > Providing urgent or procedures, to a known or emergency dental care, not suspected COVID-19 patient. > Performing aerosol-generating involving aerosol-generating procedures on well patients. procedures, to well patients > Very High (i.e., to members of the > Performing aerosol-generating general public who are not procedures on known or susknown or suspected COVID-19 pected COVID-19 patients. patients). > Working at busy staff work > Collecting or handling speciareas within a dentistry mens from known or suspected facility. COVID-19 patients.
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The ADA has provided interim mask and face shield guidelines that align with existing CDC recommendations for patients without signs or symptoms of COVID-19, including: > It should be assumed that all patients can transmit disease. > Use the highest level of PPE available when treating patients to reduce risk. > N95 masks – Level of risk: Low > N95 equivalent masks, KN/ KP95, PFF2, P2, DS/DL2, Korean Special 1st – Level of risk: Low > Surgical mask – Level of risk: Moderate > If masks with either googles or face shields are not available, please understand there is a higher risk for infection. > Use your professional judgement related to the treatment provided and the patient’s risk factors. Meanwhile, for those dentists reopening their doors, the ADA’s Advisory Task Force on Dental Practice Recovery has developed the free “Return to Work Interim Guidance Toolkit.” It includes: > Welcome back reassurance sample letter to patients > Guidance on pre-appointment screening > In-office patient registration procedures > Reception area preparation strategies > Chairside checklist
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> Staff protection strategies > Supplies shopping list The ADA’s Advisory Task Force on Dental Practice Recovery began meeting in April with the overall goal of helping dentists get back to serving their communities while protecting patients, office staff and themselves. It is comprised of practicing dentists with support from ADA experts in science, practice, law, regulation and other key areas. Drs. Rudy Liddell, chair of the ADA Council on Dental Practice, and Kirk Norbo, 16th District trustee, are the co-chairs for the advisory task force. To further help dentists reenter their offices, the Organization for Safety, Asepsis, and Prevention (OSAP) has provided an on-demand webinar on respiratory protection in the era of COVID-19. The webinar discusses: > Steps to introduce the use of N95 and other respirators in dental settings > Practical tips for developing the OSHA respiratory protection program, including fit-testing, medical evaluation and training > Different levels of surgical masks and how they compare to N95 respirators > Proper steps for donning and doffing of all PPE Video highlights also include: > How to put on and take off PPE > Droplet and airborne transmission precautions for the dental team > Using respirators and surgical masks in dental setting during COVID-19
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> Understanding FDA and OSHA requirements for using respirators for confirmed or suspected COVID-19 patients > How to optimize PPE > OSAP experts answering dental community questions about PPE
The impact of COVID-19 is unprecedented. Given the rapid spread to date, DSOs should consider a set of actions: protect and provide purpose to employees, stress-test financials, stabilize critical functions, engage with patients and leverage online training.
Aspen Dental New York-based Aspen Dental is taking proactive steps so that patients, care teams and communities have a safe, clean care environment for their dental needs. They are committed to the highest safety standards and now, deep cleaning has taken on a whole new meaning. All care team members must wear PPE such as masks when working with patients, whether they are at the front desk or in a treatment room. Equipment is sterilized and dental chairs and all surfaces are cleaned between each patient. Surfaces in waiting rooms and common areas are cleaned hourly to keep high touch surfaces clean. Hand sanitizer is available throughout the office. Patients are being asked to arrive on time, not early, to minimize time spent in the office. Patients are quickly moved into their treatment room upon arrival. If a wait is required, patients are asked to wear a mask and wait outside the office, preferably in the car, before an appointment. They are texted when they are ready to be seen. Also, family and friends of the patients are asked to wait outside the office unless the patient requires personal assistance during their visit. If so, their companions are checked for symptoms, given a mask, and wait outside during the appointment. Team members are checked daily for signs or symptoms of illness, including mandatory temperature checks. Care team members who show any signs or symptoms of a cold, seasonal flu or COVID-19 must stay home until they have been cleared by their healthcare provider. All patients are screened before starting care to assess their COVID-19 risk, including temperature check and symptom screening. Appointment times are staggered to limit the number of people arriving to the office at any given time. Where possible, high-risk patients will be scheduled earlier in the day, when the office is less busy, to minimize unnecessary contact. Aspen Dental encourages patients to complete their paperwork online in advance of their appointment to minimize paper in the office. And, they have eliminated paper sign in at the front desk.
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> Sponsored : Align Technology
Achieving practice growth through the use of digital treatment options One clinician’s treatment journey with the Invisalign system :
ALLISON WALKER
Digital technology and workflows bring a new level of efficiency and ease to a growing number of dental practices. Dr. Shorouq Sahawneh, lead dentist with Smile Brands Inc. (SBI), and Clinical Director and Professional Corporation (PC) President of all southern California offices, knows this well.
Dr. Sahawneh and her team
Throughout her 12-year career, Dr. Sahawneh has been fascinated with technology. Embracing new digital innovations has allowed her to save time, enhance patient communication, and see Smile Brands, Inc. continue to expand. “We have almost 72 offices in southern California and we’re growing,” she says.
“It’s been an amazing journey and I’m very grateful.” When Align Technology introduced the Invisalign Go system to Smile Brands and their general dentists in 2017, Dr. Sahawneh was given the opportunity to practice in orthodontics, an area of longtime interest. “I loved that Invisalign treatment
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helped me offer more comprehensive care. It helped me take advantage of a new area of untapped potential to help my patients.” Dr. Sahawneh prescribed everything from restorative dentistry, extractions, and implants to her patients but had to refer all of her orthodontic cases to a specialist. “With Invisalign Go, I was able to provide my patients with orthodontic treatment. Achieving a straighter smile was a helpful first step in planning future restorative work more effectively and achieving better overall results for my patients,” she explains. Dr. Sahawneh points out that incorporating Invisalign treatment into the practice workflow is a team effort. The training and support provided by Align Technology are critical to getting up to speed and mastering the different components of the Invisalign Go System – from the Invisalign Photo Uploader through the intuitive ClinCheck treatment planning software. “Align Technology’s Invisalign Pro course, featuring one-on-one tutoring, was a tremendous opportunity to learn from an expert orthodontist while going at my own pace. It helped me become who I am and built so much confidence in my ability.”
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Today, an orthodontic assessment is part of every patient’s evaluation and oral examination at Dr. Sahawneh’s practice. “I’m connecting the position of the patient’s teeth, their occlusion and misalignment, to the conditions that they complain about,” Dr. Sahawneh explains. “We are educating patients during periodic appointments that filling a chip or recession with composite is just a temporary fix and we need to treat the cause or the root of the problem—the malocclusion.” Dr. Sahawneh started her Invisalign journey through utilizing the Case Assessment tool in the Invisalign Go system, which gave her a sense of assurance and confidence to assist her in determining if the patient was a candidate for the Invisalign Go treatment. After about a year, though, Dr. Sahawneh felt confident enough to do her own case assessments. “By this point, my practice was the top office in the whole company based on our number of Invisalign Go cases. But I felt limited and that there where situations where I could provide a more ideal outcome for my patients,” she recalls. Dr. Sahawneh had been relying on standard impressions to start her Invisalign Go cases. She believed that starting the digital journey with a digital scan would further streamline the process for her team and for her patients. “Smile Brands’ leadership team was supportive, so we added an iTero intraoral scanner to my office,” she says. Combining her advanced knowledge of Invisalign treatment options while utilizing the enhanced visualization tools, such as the Outcome
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Simulator available on the iTero scanner, gave her more confidence in case selection and efficient treatment planning. “Now we have more knowledge and can see the bigger picture of what to expect at the end of the case,” she explained. The iTero scanner helped Dr. Sahawneh tap into something even more important than cost savings and efficiency. The Outcome Simulation feature helped her connect with her patients on a real and
cases. “No more impressions!” she exclaims. “It has reduced my percentage of crown and bridge re-dos. In addition, don’t forget that at the end of the day, it enhances patient experience.” In fact, Dr. Sahawneh and her team have been discussing the need for a second iTero scanner. “We’re using it on every single patient—restorative, prosthetic, Invisalign treatment, all new patients, and for progress assessment in recurring patients.”
The Invisalign Outcome Simulator and the Invisalign Go Case Assessment tool.
powerful emotional level. “Patients know from looking in the mirror that they have crowding or malocclusion,” she noted. “But looking at a 3D image on a screen tells a completely different story. It opens up their eyes. They often say they didn’t know it was that bad. Even just looking at their scans before getting to the simulation step is really helpful for them,” she explains. “One great thing is the iTero allows us to email them the simulation we created so they can look at it again and show it to their family. That is really awesome! It gives patients more confidence in their decision making and usually leads to a better outcome for case acceptance.” Dr. Sahawneh uses the iTero scanner for 100% of her restorative
Dr. Sahawneh finds these digital technologies reinvigorating. She admits that in the past, she had gotten to a point where she felt “capped out” with regard to both dental procedures and production. “However, adding the Invisalign system and the iTero scanner to my practice created so many opportunities and took my office to the next level. It’s been amazing.” In her opinion, connecting the iTero scanner to Invisalign treatments has added an additional line of business to her practice. “It took my revenue and production through the roof,” she says. “We’re literally hitting our goals every single month and offering Invisalign treatment to our patients is a big part of that success.”
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> Infection Control
Standard operating procedures for infection prevention Uniformity, efficiency, productivity and competence
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.
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The military, business and medical literature is filled with information on the creation and utilization of Standard Operating Procedures (SOPs). Designed to create uniformity, efficiency, productivity and competence in the workplace, SOPs are crucial to infection prevention. According to the U.S. Army, an SOP is “a clearly written set of instructions for methods detailing the procedures for carrying out a routine or recurring task or study.”1 In the business world, an SOP may be described as “a step by step guide on how an employee’s work process should run providing detailed guides or guidelines for an employee.”2 In medicine, SOPs can be defined as “a specific set of practices that are required to be initiated and followed when specific circumstances arise. For example, emergency room physicians have SOPs for patients who are brought in an unconscious state; nurses in an operating theater have SOPs for the forceps and swabs they hand to surgeons; and laboratory technicians have SOPs for handling, testing, and subsequently discarding body fluids obtained from patients.”3
SOPs are critical to infection control and prevention in dentistry as well. They create a foundation for team training and effective, site-specific procedures, which have a positive impact on the safety of dental team members and patients.
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Where to begin? The Occupational Safety and Health Administration (OSHA) states that each practice must have an individual designated as the safety manager, while the Centers for Disease Control
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and Prevention (CDC) states that one person in the dental practice who is trained in infection prevention be designated as the infection prevention coordinator. 4,5,6 In some cases, this is the same individual, but not always, as the roles outline varying responsibilities. For the purposes of this article, the focus will be on the role of the Infection Prevention Coordinator, also referred to as the Infection Control Coordinator (ICC). According to the CDC, one duty of the ICC is to develop written infection prevention policies and procedures based on evidence-based guidelines, regulations or standards – in other words, infection prevention SOPs. The CDC goes on to say that these policies and procedures should be tailored to the dental setting and reassessed annually.6 An example of this could be an SOP for operatory cleaning and disinfection. This SOP creates a standard process in the specific practice for all team members and leaves no room for question around how to achieve compliance. The job of the ICC is extremely important to the practice and should be delegated to a team member who is truly willing to be committed to the position. The dentist or management team should really assess their team to determine who is best suited and will be dedicated to the ICC position. The ICC is also responsible for providing supplies necessary for adherence to Standard Precautions (e.g., hand hygiene products, safer devices to reduce percutaneous injuries, personal protective equipment).6
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In a recent article by Eklund, she cites the Organization for Safety Asepsis and Prevention (OSAP) sample job description for the ICC, which includes a number of tasks, including: > Review existing policies and SOPs to identify gaps and outdated information. > Act as a resource for dental team personnel. > Maintain relevant documentation, including records, permits and licenses. > Provide infection prevention education and training for new and existing personnel. > Monitor compliance with written policies and procedures through observation, checklists and other evaluation methods.7 The role of the ICC is to manage and provide oversight of the infection control program in the dental practice. Although this team member is the key person for infection control, it is vital for the doctor/employer to promote a culture of safety and support the efforts of the ICC so the entire team is focused on infection prevention, a safe workplace and compliance to set SOPs.
Resources for the ICC Almost any team member who has been designated as the practice ICC will say it is not an easy job. Whether new to the position or not, it may be overwhelming to review the assigned tasks for infection control and determine where and how to find resources. Fortunately, there is no need to try and re-invent the wheel, as there are some key organizations that can assist in developing written SOPs for the practice.
> The Organization for Safety, Asepsis and Prevention (OSAP)
> OSAP’s mission is to be the world’s leading provider of education that supports safe dental visits. The organization focuses both on strategies to improve compliance with safe practices and on building a strong network of recognized infection control experts. OSAP offers an extensive online collection of resources, publications, FAQs, checklists and toolkits to help dental professionals deliver the safest dental visit possible for their patients.8 The toolkits and checklists are current and science-based and can be used to form the foundation of the practice’s infection control SOPs.
> CDC > The Summary of Infection Prevention Practices in Dental Settings; Basic Expectations for Safe Care is filled with evidence-based sound information, key recommendations and best of all, two checklists. These checklists can be used as self-audit tools to guide dental team members through a practice evaluation of their
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infection control protocols and compliance to CDC guidelines. More specifically, the checklists were developed to 1) ensure the dental healthcare setting has appropriate infection prevention policies and practices in place, and 2) to systematically assess personnel compliance with expected infection prevention practices and to provide feedback to dental healthcare personnel regarding performance.6 Although site-specific written SOPs are needed for each individual practice, group practice or DSO, these checklists can be used as a tool to serve as the basis for developing and implementing the necessary SOPs.
> Greenlight Dental Compliance Center by Hu-Friedy
> This online resource helps the ICC create site-specific, customized infection prevention protocols by providing templates and methods to import required materials, such as instructions for use (IFU) for equipment or products. Having prepared, ready-to-go templates that incorporate CDC, state regulations and OSHA (pertaining to infection control), simplifies the overwhelming task of creating the necessary
infection control SOPs for the practice. Greenlight also provides the ICC and facility with access to online continuing education on OSHA and other topics, regulatory standards and state requirements, training and resources designed specifically for the ICC, regular online infection prevention self- assessment, breach response resources and tools and complimentary consultation for new members. Once SOPs are created via Greenlight, they can be updated as needed, used for training of new and existing team members and to monitor compliance to the protocols.9,10
Benefits of SOPs Cameron lists five business benefits of SOPs, which can easily be applied to the dental setting11: 1. SOPs maintain quality control and help ensure everyone is on the same page regarding how to get the job done. In the dental setting, infection control tasks are often completed because that’s the way it’s always been done. Creating and using written infection control SOPs will instill a sense of accountability and ensure that best practices are maintained over time.9,11 2. SOPs help ensure everything runs properly, like clockwork. In the dental setting (particularly with regard to DSOs and large groups) schedules and patient care need to run like clockwork to ensure a positive patient experience and staff satisfaction. If dental team
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members do not have SOPs to follow, there can be inefficiencies in workflow that could have a negative impact on both. Imagine not knowing the office procedures for disinfection and sterilization of dental instruments. Not only can mistakes cause injury or illness to patients or team members, there is a potential for lost revenue as well.11 3. SOPs are invaluable for training purposes. Having procedures in writing means that employees are trained on how to do things via a step by step process that is easily referenced by anyone who needs to look things up.11 There is a saying that old habits die hard. In dentistry, SOPs that reflect evidence-based guidelines for infection prevention and safety help divert possible bad behaviors that may accompany new employees.9 For existing team members, SOPs aim to continually calibrate protocols and procedures. 4. SOPs are in place to maintain compliance. In any business, including dentistry, certain procedures related to safety must be done a specified way because of regulatory or government standards such as OSHA. SOPs help protect the practice from potential disciplinary action, citations or fines related to non-compliance.9,11 5. SOPs are helpful during crisis management. When things go wrong, people don’t think clearly. In the case of a fire, a medical emergency or an occupational exposure accident, it’s essential to have systems in place and SOPs to follow. If team members can jump into action on auto pilot because they’ve
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GreenLight Dental Compliance Center logo courtesy of Hu-Friedy
> Infection Control
been trained how to handle specific emergencies, it can save the day.11 Standard Operating Procedures for infection prevention are vital to the dental practice to ensure consistency, efficiency and safety and there are good resources that can simplify
the process. Regardless of the dental setting, management can’t always be around to issue instructions to team members, and that’s where SOPs shine. Knowing the step-by-step procedure for each task in infection prevention means that the team is empowered to act without waiting
for directives. Infection prevention impacts both patient and team safety. SOPs can reduce the chance of errors and the potential for situations where team members might claim they didn’t know how to react because there wasn’t a written procedure to follow.11
References 1. U.S. Army Public Health Command. Writing and operating a standard operating procedure. October 2010. Available at https://phc.amedd.army.mil/PHC%20Resource%20Library/TG%20176%20Writing%20and%20Managing%20 a%20Standing%20Operating%20Procedure.pdf. Accessed March 6, 2020. 2. Time Clock Wizard. The benefits of standard operating procedures in 2019. December 2018. Available at https://www.timeclockwizard.com/benefits-of-standard-operating-procedures. Accessed March 6, 2020. 3. Rao TS, Radhakrishnan R, Andrade C. Standard operating procedures for clinical practice. Indian J Psychiatry. 2011;53(1):1–3. doi:10.4103/0019-5545.75542. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056180/. Accessed March 6, 2020. 4. U.S. Department of Labor. Occupational Safety and Health Administration. Bloodborne Pathogens. Available at https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS. Accessed March 6, 2020. 5. Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-care Settings – 2003. MMWR 2003;52(No. RR-17):(6). 6. 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. 7. Eklund K. Role of the Infection Prevention Coordinator. Decisions in Dentistry; Feb 2020:23-25. 8. Organization for Safety Asepsis and Prevention. About OSAP. Available at https://www.osap.org/page/AboutOSAP. Accessed March 8, 2020. 9. Wilson J. Five reasons why every practice needs a written infection prevention protocol. Efficiency in Group Practice; Nov-Dec 2019:40-41. 10. Hu-Friedy. Infection Prevention – Is Your Practice Doing Enough? Available at https://www.hu-friedy.com/blog/greenlight-dental-compliance-center. Accessed March 8, 2020. 11. Cameron S. What are the benefits of SOPs? Bizfluent; Business Operations: May 31, 2019. Available at https://bizfluent.com/info-8416973-benefits-sops.html. Accessed March 8, 2020.
> Infection Prevention
Protecting the patient Let patients know what and why you do the things you do to keep them healthy and safe.
Holiday time is family time and joy for most everyone. Yet most of us have a dysfunctional family in some way or another. Dysfunction can be understood by thinking of a wind-chime. If one piece starts moving, it moves other pieces. Sometimes the sound is harmonious but often becomes a horrid clang of dysfunction.
Patti DiGangi, RDH, BS Patti believes dentistry is no longer just about fixing teeth; dentistry is oral medicine. AND its time we got around to truly practicing it. Her new brand: Beyond Oral Health challenges us do so. Patti’s specialty is coding-medically necessary coding. Her efforts have assisted thousands of professionals to code more accurately and efficiently. She teaches the why behind the codes. Patti holds publishing and speaking licenses with ADA for Current Dental Terminology©2020. Patti’s passion for infection protection is based on her personal health and allergies. She wants everyone to be protected.
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A family is a system. Every day in your work, you probably interact with dozens of systems. Dentistry is filled with systems. Some effective, some whose time has come and gone but are still being used. One very important area in dentistry needing a systems approach is infection protection. A functional family of related products can help everyone in the practice family get it right without guessing. The Centers for Disease Control (CDC) Summary of Infection Prevention Practices in Dental Settings and the Infection Prevention Checklist for Dental Settings state, “Infection prevention must be made a priority in any dental health care setting. At least one individual with training in infection prevention—the infection prevention coordinator—should be responsible for developing written infection prevention policies… appropriate training and education of dental health care personnel (DHCP) on infection prevention practices, and adequate
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supplies to allow DHCP to provide safe care and a safe working environment.’ That sounds great and is important. At the same time, anyone who worked in a dental practice more than a half-hour knows, the ideal isn’t the way a practice necessarily or often works. Those working in a dental practice become a family and act as a system. It can be a dysfunctional family. Starting the day with a team huddle gets the team on the same page each day. Huddles aim to refocus everyone’s attention after the morning rush. They enable the team to dial in together before breaking for the day. In other words, the best of plans can still get derailed. The first patient comes late for their hygiene appointment. The other hygiene patient needs an extensive conversation with the dentist. The computers aren’t booting. So many issues arise that take precedence that pulls every person in the practice. With hygiene running so far behind, one of the assistants is asked
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to turn over the room and seating the next person. Yet the assistant can’t because the dentist has something more pressing for her to do. The business assistant is feeling the pressure because a patient who has been waiting for his appointment comes to back to ask when he can be seated. She is pulled in to turn over the room. She is in a bit of hurry because the dentist’s patient is being released and she needs to set up the financial plan. And of course, three phone lines are ringing. All of this can lead to rushing through the important infection protection procedures. The business assistant isn’t as clear as others about the procedures or even the products just because she doesn’t perform the procedures as often as others. Or think if it got crazy enough for the dentist to need to perform the room turnover! Again, if you have worked in a dental practice more than a halfhour, you are seeing and even reliving the scenario. It can all be made easier. How? Systems thinking with a functional family of products. The Monarch line of infection prevention products provide that system. It’s color-coded to make it easier even for those less practiced at infection protection. From surface cleaning and disinfection, instrument cleaning, equipment maintenance to personal skin and hand protection, the Monarch family of Infection Prevention merchandise makes it easier to make the right choices for the right surfaces at the right time. > Green: The Monarch Surface Disinfectant products provide
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broad spectrum kill of 25 pathogens in one minute. These wipes and sprays have green lids and identification so anyone in the practice can know these are safe and compatible to for use hard surfaces in the dental office. The vinyl upholstery cleaner is also identified by the green color cleans and cares our chairs without leaving any residue; giving a silky gloss finish.
> Blue: The blue color products for Instrument Cleaning starts with Monarch Safety Tray that facilitates easy and safe instrument processing. This is particularly important for those less familiar with the room turn-over process though it is equally important to those who perform it routinely. Monarch Enzymatic Cleaner is an effective multi-enzymatic cleaning concentrate formula using five synergistic enzymes for complete instrument cleaning prior to sterilization.
> Yellow: The products that are yellow are very important to the office long term functioning of equipment-a major investment in most practices. Monarch CleanStream is designed for use with Air Techniques and all other vacuum systems, wet or dry. It removes and prevents future line build-up, increasing vacuum performance and suction and cleans and deodorizes evacuation lines. Monarch Lines Cleaner is the perfect solution to remove microbial build-up in tubing lines without the use of
harsh chemical. For daily use in water bottle, weekly cleaning, and intermittent treatment to clear deposits from waterlines. Ready to use; no mixing or diluting is required.
> Pink: Finally, the pink products for protection of the person performing the infection protection procedures. Monarch Hydrating Instant Hand Sanitizer formula kills 99.99% of widespread germs. It is a waterless, alcohol-based gel that contains Aloe Vera for smooth application and silky feel. The Monarch Revitalizing Hand Lotion contains a special wax formulation makes donning gloves easier. It is enriched with Aloe, Vitamin E and B complex and leaves hands smooth and silky; never oily. It provides long-lasting moisturizing effect, even after several hand washes. With more than 50 million Americans experiencing various types of allergies each year and allergies as the sixth leading cause of chronic illness in the U.S., the choice made every moment by every person in a dental practice is important to protect our patients. Those working in a dental practice become a family and act as a system. Using systems for infection protection that coordinate and function together can give the best outcome. The Monarch family of functional Infection Protection merchandize help practice families make the best choice creating beautiful music of health and safety together.
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> Group Practice Profile
Strength in experience Collaboration between team members drives quality patient care and continuous growth within the practice.
When Park Dental welcomed its first patients nearly 50 years ago, the group practice concept was newly evolving. Through team collaboration, however, the Minnesota- and Wisconsin-based dental practice has established itself as a high-quality provider of a wide range of patient services. Today, Park Dental boasts 51 offices and is home to over 950 doctors and team members.
“There’s no question that Park Dental has benefitted from the collaboration between our doctors and team members, ultimately driving consistent, quality patient care and service,” says Christopher E. Steele, DDS, president. “Our teams and doctors truly enjoy working together
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within a group setting, which also provides a network of general dentists and specialty clinicians who can provide a wide range of care procedures for our patients.” Collaboration has also helped foster engaging external relationships in the dental industry, he continues.
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“The significant opportunities found in a group environment allow for professional development and continuous learning for our doctors and team members,” he says. “For example, our dentists and clinical team members undergo continuous peer review to ensure our standard of care excellence is upheld. In addition, leveraging our scale creates opportunities for practice acquisitions and the ability to reduce expenses, whether capital, technology or basic supplies.” Park Dental is accredited through the AAAHC, ensuring it is compliant
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with regulatory and quality control measures of care, notes Dr. Steele. “Our doctors, team members and patients also appreciate the consistent care culture; our doctors and team members can provide clinical care at multiple Park Dental locations, whether assigned or substituting for another team member.” And the fact that all of the group’s offices have Park Dental as part of their name has made it substantially easier for new patients to recognize them, which is critical in expanding markets, he points out. “Each year, we receive feedback from over 30,000 Park Dental patients and the results are approaching a 98 percent patient satisfaction rating,” says Dr. Steele. “We have found that our patients especially value Park Dental’s consistency of quality care (including comprehensive services), a conservative care-model and the ability to transfer within practices based on home-work geography. Patients also value building relationships with their clinical care team members who communicate effectively; our patients understand their dental health and are offered a full suite of preventative and restorative service.” Efficiency in Group Practice: How has being part of a group practice impacted the responsibilities of your support staff? Christopher E. Steele, DDS, President, Park Dental: There is strength in expertise. As a dental group, our doctors and clinical team members can focus on providing the best care for our patients. Park Dental doctors and patients benefit from standardized patient records, patient care
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protocols and state-of-the-art facilities and equipment. We also have dedicated support teams providing clinical training/mentoring and development, and improving the patient experience. All activities indirectly related to patient care, such as marketing, finance, facilities, team relations and talent acquisition, are addressed separately by teams within our group. By focusing our responsibilities, we feel the overall talent of our teams continues to improve.
this is one of our biggest obstacles. Ultimately, all decisions are made for the group as a whole, which may also push the timeline for a workgroup to evaluate a new technology versus one individual’s decision. However, we can leverage our purchasing scale to reduce our technology costs so we can balance the best technologies against the resulting care improvements. With our stateof-the-art technology, such as CBCT, scanning, lasers, milling and digital
Our doctors, hygienists and assistants continue to have important conversations with patients about the oral-systemic connection, which is driven by continuing education and mentoring. Efficiency in Group Practice: How does your practice implement new technology efficiently and effectively? Dr. Steele: Park Dental, like many practices, identifies new technology through our doctors, team members and management team interactions. Prior to total organizational implementation and appropriate training, we evaluate the viability of the technology – first with a technology workgroup, followed by pilot testing at a limited number of our practices. (A doctor lead verifies function.) The group practice concept allows us to truly assess technology and how it will improve our care prior to purchase. Individual preferences and strengths vary within the group, and
radiographs, we can perform a wider range of procedures in-house or with an adjoining Park Dental practice, which provides efficient care for our patients. Efficiency in Group Practice: How does Park Dental attract - and retain – top notch clinicians and team members? Dr. Steele: Our group practice model has helped us understand, recruit and retain new doctors and team members. We realize our success is completely dependent on attracting talented individuals who will assimilate into our culture, while maintaining their generational value system, work patterns and communication preferences. Our goal is to
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> Group Practice Profile
gain their appreciation and trust in the value of consistent, high-quality, patient-centered care. Our reciprocal duty is to recognize their value system and provide an environment that suits their needs clinically, socially and, with regard to Millennials, financially given their respective student loan debts. Since Park Dental is a group practice, we have the scale to offer sponsored CEs to our doctors and clinical team members. Our continuing education program is aimed at clinical excellence for our doctors/team members and represents areas of clinical need within our group and that of the dental industry. We provide extensive internal CE, as well as a yearly stipend to help reduce the debt burden for millennial dental students in particular. Another benefit of segregated responsibilities is that it allows better work/life balance. Our doctors and clinical team members can focus on providing patient-centered care, while support teams such as finance, marketing, IT, talent acquisition, patient experience and team relations focus on their respective subject matter. As with most groups, there is always a support structure for dentists, including a shared on-call schedule. Efficiency in Group Practice: How has the connection between oral and physical health impacted the way your clinicians, hygienists and assistants work with patients? Dr. Steele: The link between oral health and overall health continues to evolve. Park Dental has historically tracked systemic health during
Top workplace In 2018 and 2019, Park Dental, a group practice comprised of 51 offices in Minnesota and Wisconsin, was named a Top Workplace by the Star Tribune newspaper. “The evaluation for the Top Workplace program is based on feedback from doctor and team member surveys,” says Christopher E. Steele, DDS, president. “Our engagement survey scores were recognized as a National Standard Top Workplace, and we feel strongly that internal surveys are as critical as patient surveys in assessing our practice culture.”
our patient visits. We continue to develop systems within our electronic dental record to recognize the health benefits of comprehensive oral health with improved systemic health. One recent example would be our implementation of sleep screening into our exam protocol. Our doctors, hygienists and assistants continue to have important conversations with patients about the oral-systemic connection, which is driven by continuing education and mentoring. One recent change is that overall health conversations are driven by a more informed patient base. Efficiency in Group Practice: Has being part of a group practice given you better tools to provide more holistic patient care? Dr. Steele: Without question, being part of a group practice has given us better tools to leverage our scale to provide a focus on holistic patient care with respect to coordinated training, mentoring, data collection within our electronic dental record and, finally, the application
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of data to patient health improvement. Connecting the dots is critical for our patients’ health and their perception of our care. While the large group practice model has worked very well for the doctors and team members at Park Dental, Dr. Steele recognizes that there is not a one-size-fits-all model. “Dentists’ and team members’ decision where they practice should be based on their preferences and what works best for them,” he explains. “At Park Dental, our group practice is doctor-owned and led, so our focus starts with appropriate patient care and service. The group practice model, and Park Dental’s culture, provides a wonderful environment for our respective team members to thrive and develop their careers in a rewarding manner. We understand that either model (solo versus group) can provide care and service to all patients, and ultimately that’s what the profession is all about. Yet, our belief is that group practice is a model that affords multiple rewards to patients, doctors and team members, which exemplifies the profession.
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> Operations and Development
Dental industry disruption: A different dental context By Kristine Berry, RDH, MSEC
As dental communities and individuals, we have moved into the 21st century in a world of developing technologies, disruption and VUCA. VUCA is a concept that originated with students at the U.S. Army War College to describe the volatility, uncertainty, complexity and ambiguity of the world: > Volatile. Rapid, sudden, constant change. > Uncertain. Unclear information and outcomes. > Complex. Multiplicity of variable and unknowns. > Ambiguous. Lack of clarity about meaning of event.
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VUCA is gaining new relevance in health and wellness, and as leaders and providers, you are being called on to successfully navigate this concept to promote your values, vision and purpose, the evolving need of patients and your organization’s bottom line. We are
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> Operations and Development
at a turning point of discovery, confronting a moment when the traditional practice models are up for grabs and new models are developing. Innovation is required, as well as the ability to be flexible. This article will outline an example of positive complexity: telehealth and teledentistry. It will provide a fundamental backdrop of considerations of teledentistry and describe how –by integrating steps and reframing conventional delivery of services – we have an opportunity to create certainty in our practices and organizations.
A teledental visit can give patients improved access to information about the importance of oral health and extensive education opportunities. In a value-based world, additional uses include teaching, mentoring, calibration, research, patient screenings, specialty consultations, pre- and post-operative care, follow-up and distance learning and coaching. > Remote patient monitoring (RPM). Collecting personal health, medical and dental data from a single individual via electronic medical devices and dental technologies. (The data is transmitted to a different location – sometimes via a data processing service – where the provider can access it for monitoring conditions and supporting care delivery.)
What is telehealth? According to the Center for Connected Health Policy, “telehealth is a collection of means or methods for enhancing healthcare, public health and health education delivery and support using telecommunications technologies. Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical health, health coaching and education services.” Telehealth is not a specific service, but a collection of means to enhance care, coaching and education delivered from a distance (remotely), such as: > Live-video teleconference appointments, either scheduled or on demand (synchronous).
> Store-and-forward (asynchronous) transmission of radiographs, photographs, video and digital impressions through a secure electronic communications system to a practitioner. (This information is then used to diagnose or provide a service.)
> Mobile health (mHealth), or health and oral care education, health coaching, practice and delivery provided via mobile communication devices, such as cell phones, tablet computers and personal digital assistants (PDA). The American Teledentistry Association defines teledentistry as: … the use of electronic information, imaging and communication technologies, including interactive audio, video and data communications, as well as store and forward technologies to provide and support dental care delivery, diagnosis, consultation, treatment, transfer of dental information and education. An example of a teledental visit is a videoconference between a provider
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and a patient regarding an urgent dental or oral health problem. A teledental visit can give patients improved access to information about the importance of oral health and extensive education opportunities. In a value-based world, additional uses include teaching, mentoring, calibration, research, patient screenings, specialty consultations, pre- and post-operative care, follow-up and distance learning and coaching. In addition, teledentistry eliminates geographical barriers by bringing many providers together and allows for new collaborative care between providers/specialists. With regard to evidence-based modalities, telehealth applications have been shown to be highly beneficial for the management of chronic diseases and their awareness of health.
Implementation and sustainability If you foresee incorporating teledentistry into your existing model, it’s necessary to ensure your choices of telehealth programs are in line with your strategic goals and objectives. To ensure sustainability and financial and clinical success, it is essential that teledentistry is fully integrated into your existing clinical processes.
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Ask yourself the following: > Will your choices reflect your values, purpose and vision? > Do you support developing partnerships with other healthcare providers and organizations? > Do you believe in – and are you committed to – teledentistry as a process to improve patient outcomes and provide increased access to care outside your brick
> Have you performed
and mortar locations(s)?
> Do you value continuing development, such that providers can develop added knowledge, skills and abilities by learning from specialists and collaborating with healthcare providers? > Is care management and technology a value proposition? > What services are most needed in your organization?
organizational assessments to determine your readiness in the adoption of telehealth technologies, as well as the leadership’s and team’s readiness to change?
> Is there buy-in or commitment to the additional work involved in developing a telehealth line of business?
> Do you understand what your state licensure permits, as well as any legal or regulatory issues?
> Have you appointed a point-person or consultant who understands the role as an agent of change for developing a sustainable model? With a solid framework and implementation strategy, your organization can realize the full potential of teledentistry. Whether you adopt a synchronous or asynchronous method, you can apply different clinical teledentistry delivery systems. In a value-based world, telehealth and teledentistry will be important models for improving quality access to care and maintaining your organization’s top – and bottom – line.
Resources: Kopycka-Kedzierawski DT, Billings RJ, McConnochie KM. “Dental screening of preschool children using teledentistry: a feasibility study”. Pediatr Dent. 2007; 29(3): 209-13. 2017 U.S. Telemedicine Benchmark Survey – REACH. Finger Lakes Community Health, Teledentistry, Reaching out with Technology, Anthony Mendicino, DDA. https://localcommunityhealth.com/sodus-providers/ https://www.cchpca.org/ https://www.americanteledentistry.org
Kristine Berry RDH, MSEC 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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> Safest Dental VisitTM
Put your patients at ease
The overwhelming majority of dental practices work very hard to ensure their patients’ safety and health during treatment, according to 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™ OSAP – and it’s important for doctors and team members to convey that to their patients.
By discussing the following points, which are based on current dental infection control recommendations from the Centers for Disease Control and Prevention (CDC), the American Dental Association (ADA) and OSAP, the dental team can reassure patients they are in a safe environment, protected from the spread of infection.
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> We sterilize all dental instruments, including handpieces, between patients. In keeping with Centers for Disease Control and Prevention, American Dental Association, and OSAP recommendations, dental professionals should be heat-sterilizing all
instruments that penetrate or contact a patient’s oral tissues. Although autoclaves are most commonly used to sterilize dental instruments, some offices may have other types of heat sterilizers. Chemical-vapor sterilizers (chemiclaves) and dry-heat sterilizers also are appropriate for sterilizing dental instruments. Instruments that have been used on a patient should be heat-sterilized before they are introduced to treat the next patient. Most dental instruments are designed to withstand repeated heat sterilization.
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> We take steps to ensure our sterilizer is working properly. Most practices use a variety of methods to ensure the office sterilizer is doing its job. In addition to monitoring the sterilizer’s gauges and readouts for proper temperature and (for autoclaves and chemical-vapor sterilizers) pressure, the dental team should wrap and seal instruments in packaging equipped with color-change indicators, which help identify instrument packages that have been sterilized, so there’s no chance that contaminated instruments could inadvertently be selected to treat the next patient. In addition, the dental team should routinely test their sterilizer using a vial or envelope containing spores. Referred to as biologic monitoring, subjecting commercially prepared, sealed spore strips or vials to a sterilization cycle, then culturing the spores to ensure they have been killed, is the highest guarantee that a sterilizer is functioning and being utilized properly. Most practices use biologic monitoring weekly or monthly in combination with color-change indicators on each instrument packet and monitoring of the sterilizer gauges and readouts.
> We change our gloves for every patient. Every dental care provider should use new gloves for each and every patient. For procedures that are likely to involve splash or spatter, the dental team should also don a new mask, as well as wear protective eyewear and apparel (possibly a gown or clinic jacket).
the treatment room for the next patient (and hopefully minimize time in the waiting area), many practices choose to cover surfaces, such as light handles, tubing and chair controls, with a plastic barrier film that keeps the surface underneath free of debris. Instead of disinfecting these surfaces between patients,
Between patients, the dental team should disinfect all the surfaces they are likely to touch during treatment. This eliminates the possibility of a dentist or auxiliary dental care provider transferring germs from a contaminated surface to the patient. > We disinfect the surfaces in the operatory between patients. Between patients, the dental team should disinfect all the surfaces they are likely to touch during treatment. This eliminates the possibility of a dentist or auxiliary dental care provider transferring germs from a contaminated surface to the patient. To save time in preparing
the dentist or dental team member simply removes and discards the barrier and places a new, clean barrier on the surface for the next patient. Most practices choose to cover some surfaces and disinfect others between patients. Some practices disinfect all surfaces between patients; others use protective barriers for all surfaces in the treatment room.
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.
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> Artificial Intelligence
Waste not, want not DSOs have the data. With artificial intelligence, they can put it to good use. Artificial intelligence is the science and engineering of making intelligent machines, especially intelligent computer programs, says the U.S. Food and Drug Administration.
How do those machines get so smart? By collecting, annotating and analyzing data. Lots of it. The kind and amount of data that some DSOs are capable of generating. “Data tells a story,” says Seth Gibree, DMD, FAGD, senior director of clinical advocacy for Heartland Dental. “It is used to analyze trends and identify potential issues and patterns of behavior – positive and negative. Obviously, the amount of data that exists is growing by the minute.”
DSOs can potentially play a big role in helping develop artificial intelligence platforms because of the amount of data that is accumulated every day, says Dr. Gibree. Heartland Dental provides non-clinical administrative support to a network that spans 37 states, with more than 1,000 supported offices and more than 1,600 supported doctors. “The more data a dental support organization has access to, the more valuable and useful we can be to strategically improve our support for the doctors and teams.”
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Is it enough data to justify building their own platform? “I think it’s possible – but very challenging – to build one’s own AI platform,” he says. “It all goes back to, What is your area of expertise? Ours at Heartland Dental is to support doctors and their teams as they deliver the highest quality dental care and experiences to the communities they serve. We would not build our own. Ideally, having strategic partners in a mutually beneficial relationship would be best.”
Possibilities, challenges Regardless of how DSOs resolve the make-or-buy decision, what isn’t up for discussion is the potential role AI can play in dentistry.
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“There could be many benefits for applying AI-based diagnostic assistance to clinicians,” says Dr. Gibree. In minutes, AI can review the amount of information a typical dentist sees over the course of their whole career. “Exponentially move out that ability to learn, and the possibility arises of highly reliable, predictable diagnosis assistance. Ultimately, it is still up to the clinician … to determine whether to proceed with treatment based on numerous factors, one of which would be predictive AI interpretation.” The potential clinical applications of AI are appealing, including
the ability to automatically chart levels of disease and bone loss based on radiographs and intraoral scans, he says. AI can also lead to more predictable, medically based treatment planning, determined by clinical presentation along with medical history and specific medical conditions, when added to the clinical judgment of dentists. For labs, it can mean better design of crowns, margin marking and material selection. Applications for the non-clinical support that Heartland Dental provides are plentiful as well, says Dr. Gibree. They include:
> Support with patient communications.
> Marketing support. > Discussions on establishing ideal office hours to meet the needs of the community. > Scheduling assistance. > Insurance verification and approval assistance. > Support with payment/billing of office patients and insurance companies. > Supply management and ordering assistance. > Collaboration on measuring patient experience. > Payroll support. > Time management assistance
Terms to know Artificial Intelligence. The science and engineering of making intelligent machines, especially intelligent computer programs. Artificial intelligence can use different techniques, including models based on statistical analysis of data, expert systems that primarily rely on if-then statements, and machine learning.
would expect a commitment on transparency and realworld performance monitoring for artificial intelligence and machine learning-based software as a medical device, as well as periodic updates to the FDA on what changes were implemented as part of the approved pre-specifications and the algorithm change protocol.
Machine Learning. An artificial intelligence technique that can be used to design and train software algorithms to learn from and act on data.
“Adaptive” or “continuously learning” algorithms. Machine-learning algorithms that can learn from new user data presented through real-world use. They don’t need manual modification to incorporate learning or updates.
“Locked” algorithms. Algorithms that don’t continually adapt or learn every time they are used. Algorithm Change Protocol, or “Predetermined Change Control Plan.” Proposed plan by FDA that would include the types of anticipated modifications—referred to as the “Software as a Medical Device Pre-Specifications”— being used to implement changes in a controlled manner that manages risks to patients. In this approach, the FDA
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Software as a Medical Device. Software intended to be used for one or more medical purposes that are not part of a hardware medical device. It can be used across a broad range of technology platforms, including medical device platforms, commercial “off-the-shelf” platforms, and virtual networks, to name a few. Source: U.S. Food and Drug Administration
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> Artificial Intelligence
“The more data a dental support organization has access to, the more valuable and useful we can be to strategically improve our support for the doctors and teams.” – Seth Gibree, DMD, FAGD, Senior Director of Clinical Advocacy for Heartland Dental
Of course, change won’t occur overnight, he says. “Change is always difficult, but it is the one constant in life. Predictability and accuracy of the AI is necessary, first. It cannot be set up for failure from the beginning. Workflow implementation, trialing and evaluation are critical to future acceptance. If it doesn’t make things better for the doctors and their team, or the patients, then adoption will be very challenging. It must make things easier.” Heartland Dental is currently evaluating numerous AI companies and products, and is working on pilots of different concepts, says Dr. Gibree. “We are evaluating AI and how it can potentially assist our supported doctors and their teams as they deliver the highest quality dental care and experiences. “I think it’s important to understand that this is still emerging technology,” he concludes. “Yes, there is lots of growth and possibility, but it is still early. We are working to understand the landscape at a high level, along with evaluating real-world applications and potential best practices for implementation. Finding strategic partners will be critical for long-term success and acceptance.”
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AI: Something new for FDA Dental providers aren’t alone in their questions about artificial intelligence. The U.S. Food and Drug Administration has a few of its own. That’s because the old rules for medical and dental device regulation – which have been around since the 1970s – don’t apply anymore, says Zach Rothstein, vice president, technology and regulatory affairs, Advanced Medical Technology Association, or AdvaMed. “In terms of regulation, the most unique aspect of AI, or machine learning, is that it can continuously learn,” he points out. “The inputs it receives in the field inform future outputs. The question is, ‘How do you truly allow for that continuous learning aspect of the device to occur?’” Thus far, the FDA has handled the question by granting marketing clearance for AI-based products that are essentially “locked,” says Rothstein. Their algorithms are typically based on thousands of data points – which make them very smart indeed. But they haven’t been FDA-cleared to get any “smarter” in the field. In other words, they are prevented from continuously learning. FDA is trying to re-imagine its approach to AI-based devices by adopting a “change management protocol,” which would establish parameters that would allow devices to continuously learn in the field. “Without that, things have to be locked,” says Rothstein. “If a developer wants to update the software of an AI device based on input received from the real world, the developer has to go back to the FDA for marketing clearance.” In April 2019, then-FDA Commissioner Scott Gottlieb announced that FDA was exploring a framework that would allow for modifications to algorithms to be made from real-world learning and adaptation. The agency is probably a few years away from figuring all this out, says Rothstein. Congressional legislation may be required for some of the changes being considered.
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> News
Dental News : DSOs, Dental Providers and Insurance
Henry Schein enhances liquidity position with new credit facility totaling $700M Henry Schein (Melville, NY) has closed on a new credit facility totaling $700 million with JP Morgan Securities LLC and U.S. Bank NA serving as Joint Lead Arrangers. The new facility represents $700 million in committed financing that increases and replaces $200 million in uncommitted financing from the same lenders. The company’s liquidity position now totals $1.7 billion. “The new financing, along with our amended existing facility, increases our financial flexibility at a critical moment in the global economy,” said Steven Paladino, executive vice president and CFO of Henry Schein. “These facilities support our effort to navigate the emerging challenges related to the COVID-19 outbreak while also helping to position Henry Schein for future growth and success.”
Delta Dental of Massachusetts donates $200,000 to support non-profits during COVID-19 Delta Dental of Massachusetts has announced three contributions totaling $200,000 to support Massachusetts non-profits in their response to community needs during the COVID-19 outbreak. The company is contributing $150,000 to The City of Boston’s Resiliency Fund, which is serving residents most impacted by the COVID-19 crisis. It is supporting non-profits that are providing food for children and seniors, technology for remote learning for students, and
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support to first responders and healthcare workers in the City of Boston. Delta Dental of Massachusetts is also contributing $25,000 to the Worcester Together COVID19 Response and Relief Fund. This fund is distributing grants and other resources to organizations across Worcester County to help residents that have been disproportionately impacted by inequities magnified in this pandemic. Finally, Delta Dental of Massachusetts is contributing $25,000 to the COVID-19 Response Fund for the Pioneer Valley. This fund is providing flexible resources to aid residents who are most vulnerable to the virus and most impacted by inequity across the Pioneer Valley.
Delta Dental of Virginia contributes $1M to support Virginia’s dental practices, patients Delta Dental of Virginia (Roanoke, VA), the state’s largest dental benefits provider, is responding to the COVID-19 crisis with a $1 million contribution to support Virginia’s dental practices and their patients, provide financial assistance for safety net dental clinics, and support local non-profits working to meet needs in their communities. The $1 million, made available through the Delta Dental of Virginia Foundation, includes: > $500,000 in grants to support continued operations for 32 dental safety net clinics that are ineligible to receive federal stimulus funds.
> $250,000 Dental Practice Relief Fund to support practices impacted by COVID-19 closures and that have minimal or no access to alternative funding sources. > $200,000 in one-time grants of up to $25,000 to nine non-profits that are working to meet local community needs relating to oral and overall health. > $50,000 to provide toothbrushes to families as part of select bagged lunch programs run by school districts and Boys & Girls Clubs.
Patient Prism provides comeback strategy for dentists Patient Prism offers a free guide for dentists to learn how to prepare for the massive pent-up demand for their services once they are open post-pandemic. Patients and team members will have more concerns than ever about the “new normal” and this roadmap is set to help dentists address questions about safety protocols, staffing, scheduling, financing and treatment acceptance. Learn how to: > Prepare your team > Set clear expectations > Build your schedule > Develop additional financing options > Communicate with patients > Advertise when you are cash-strapped > Identify and remove roadblocks > Measure results
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> News
Dupont Family Dentistry turns to teledentistry during unprecedented times Dupont Family Dentistry (Fort Wayne, IN) has transitioned to teledentistry during the COVID-19 outbreak. The office stopped all non-emergency services, but the teledentistry option is available to patients that feel they are having a dental emergency. Dr. Dave Diehl wanted to offer a place a patient could turn to, rather than going to an emergency room. The teledentistry visits cost between $30 to $50 depending on needs and is significantly less than a visit to a dentist office for an emergency.
Dental offices donate PPE to hospitals and first responders for Dental Office Challenge The Dental Office Challenge began last week to get masks and other PPE to hospitals and first responders
fighting COVID-19. Organizers of the challenge say there’s no red tape and no delays, equaling immediate help for healthcare frontlines. “Dental offices are not open now except for emergencies, so they have supplies in their storage that they’re not using right now, and our first responders and our hospitals really need it, so I’m asking that everybody get involved,” Kelly Levy of Belknap Dental Associates told television station WMUR-9. “Call your dental office. Just ask them: have they heard about this challenge? One box can make a big difference.”
Delta Dental of Kentucky designates millions to help support dental providers A commitment of up to $6 million from Delta Dental of Kentucky (Louisville, KY), along with the Delta Dental of Kentucky Foundation, will provide financial relief
to dental practices and nonprofit organizations whose operations are disrupted due to the COVID-19 pandemic. “Our focus right now is on ensuring that our many partners who help Kentuckians have healthy smiles can weather this storm,” said Jude Thompson, president and CEO of Delta Dental of Kentucky. Delta Dental of Kentucky’s new Provider Advance Payment Program makes approximately $5 million available to help supplement Kentucky dental practices that have lost income following Gov. Andy Beshear’s March 18 executive order stopping all non-emergency medical and dental procedures. The Provider Advance Payment Program offers Delta Dental of Kentucky PPO or Premier Network Providers an interest-free advance payment of up to 60% of their 2019 average monthly claims reimbursement from Delta Dental of Kentucky.
U.S. Government and Regulatory News U.S. Department of Labor data says dentists face the greatest coronavirus risks The New York Times used U.S. Department of Labor data to report on the workers who face the greatest coronavirus risk and dentists topped the list. National dentist boards updated best practice recommendations for protective equipment, urging dentists to use surgical-grade N95 masks while performing emergency procedures that cannot be rescheduled. In Vermont, Vaughn Collins, the executive director of the Vermont State Dental Society, has
been in frequent contact with the Department of Health to ensure that at least some oral surgeons across the state have access to proper equipment so that emergency procedures can be completed for Vermont residents in need.
ADA wants HHS to supply COVID-19 testing kits to dentists so they can swab patients The ADA is calling on the Trump administration to provide dentists with coronavirus tests before reopening, arguing that conditions in dental offices make patients and
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staff more susceptible to exposure. The high-speed instruments used by dental practices create aerosol clouds that can hold germs for up to three hours, increasing the odds of exposure if patient has COVID-19. OSHA has identified dental professionals as at risk for exposure due to various workplace hazards. Dentists have been advised to use either a negative pressure room or high input suction devices to remove the germs and reduce exposure once they reopen. Many offices lack those tools and facial protections.
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Virginia Dental Association responds to governor’s call to join Medical Reserve Corps The Virginia Dental Association has responded to Gov. Ralph Northam’s second call to action for medical and non-medical workers to join the Virginia Department of Health’s Medical Reserve Corps in the fight against the coronavirus. “Virginia dentists have the training to be able to support our communities during this public health crisis and I applaud the many who have already stepped up,” said VDA President Dr. Elizabeth Reynolds. “I encourage those who haven’t yet to consider volunteering with the Virginia Medical Reserve Corps to apply their medical training to the massive effort it will take to fight this virus.”
ADA warns ongoing pandemic impact likely to slash dental spending into 2021 The ADA has warned that the ongoing COVID-19 pandemic impact is likely to slash dental spending into 2021. More than 80% of dental practices reported that patient volume for the week of April 6 was less than 5% of normal. The ADA estimates that COVID-19 could lead to a two-thirds
reduction in U.S. dental spending for the year, with 2021 expected to face a 32% reduction. The ADA report says, “Even when restrictions on elective procedures are lifted, the availability of PPE for dentists could be a major constraining factor in the re-opening of dental offices.”
ADA Advisory Task Force on Dental Practice Recovery seek to address PPE shortage As dentists and staff begin plans to reopen beyond emergency procedures, substantial inventory of PPE is currently diverted to medical operations on the frontlines of the COVID-19 pandemic. “The task force is well aware of the PPE shortages nationwide at this point,” said Dr. Kirk Norbo, 16th District trustee and task force co-chair. “The face mask guidelines we have provided illustrate low and moderate risk scenarios accounting for limited access to PPE and allowing professional judgement of the dentist.” The ADA is working with reliable domestic manufacturers, key dental distributors and others to increase access to PPE for dental professionals, but according to distributors, access to masks and face
shields, along with disposable gowns, are currently the hardest to procure.
ADA president appoints task force for dental practice recovery after COVID-19 pandemic ADA President Chad Gehani has assembled an advisory task force to oversee the ADA’s development of tools for dentists as they bounce back from the effects of practice restrictions and closures caused by the COVID-19 pandemic. “The COVID-19 crisis has had a challenging impact on our dental community. Yet, the strength of our profession has never been more evident — for now, we may be distant, but we are not disconnected,” Dr. Gehani said in an April 14 letter to ADA councils and committees and dental society executive directors. “While we guide dentistry through these trying times, the American Dental Association also has its eye on what will come next.” The ADA’s Advisory Task Force on Dental Practice Recovery, which began meeting in April, has the overall goal of helping dentists get back to serving their communities while protecting patients, office staff and themselves.
Market Research RDH survey says 47% of dental hygienists wish infection control procedures would improve An RDH magazine survey from November 2019 to March 2020 asked 770 hygienists about infection control (IC) practices in their clinics. RDH explored two main findings and their significance. 1. 47% of dental hygienists wish that IC procedures in their office would improve – The CDC provides a recommended solution: an infection control coordinator – someone accountable for a feasible and sustainable infection prevention program that is dedicated to championing healthcare safety. 2. 43% of dental hygienists don’t have enough time after each appointment to complete infection control procedures – Proper cleaning, disinfecting and sterilizing take time, but many hygienists don’t work with assistants, so they often have to set aside appointment time for IC activities.
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> Editor’s Note
Infection prevention: All of the time At press time, there was little certainty around the long-term impact of Coronavirus on the country, let alone the dental industry. Would we be worse off in May? If so, how bad would it get before we’d see improvement?
Laura Thill
52
In times of uncertainty, we tend to pay closer attention to research and common sense; as so many clinical and infectious disease experts warn, doctors and dental professionals must follow infection control protocols intended to keep them and their patients safe. Even in non-pandemic times, however, dental professionals face constant exposure to microorganisms from dental unit waterlines and bioaerosols, which are generated by dynamic dental instruments, according to Leann Keefer, RDH, MSM, director, clinical services & education, Crosstex International, now a proud member of HuFriedyGroup. Splash, splatter and submicron aerosols are a source of potential infection. And, because submicron particles are known to stay airborne for up to 30 minutes following an ultrasonic scaling procedure, the risk does not end once the procedure is over or the patient leaves the operatory. It’s imperative for the dental team to wear face masks, she says. “The smaller the size (of particles generated by aerosol and splatter), the greater the potential it will be inhaled and penetrate and lodge in the lungs, which is thought to carry the greatest potential for transmitting infections. Additionally, because these submicron particles stay airborne for extended periods, dental clinicians and team members must opt to don/wear, at a minimum, a Level 1 mask between patients when they are turning/cleaning the treatment room.” In fact, as dental team members are tasked with a growing list of responsibilities, it is more important than ever before that they follow recommended safety standards. Hygienists
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are a prime example. Indeed, many hygienists today are a significant part of the dental team, according to Jennifer Rush, RDH, BSDH, director of dental hygiene, DecisionOne Dental Partners. “At DecisionOne Dental Partners we look at the hygienist not just as a team member, but as a clinician,” she says. “Our patients see more of their hygienists than any other healthcare provider.” In fact, many hygienists today are more involved in treatment plans and post-operative procedures, she adds. As such, hygienists at DecisionOne are encouraged to be role models in infection control and adhering to safety protocols. All team members, including administrative personnel, receive in-person OSHA/HIPAA training and online webinar training, and infection prevention quality control measurements are shared through the use of team member evaluations. DSOs emphasize infection control throughout their organization, says Andrea Kowalczyk, RDH, BS, lead talent acquisition partner for a leading DSO. “Many of our groups employ quality assurance officers who ensure the entire dental team complies with OSHA guidelines,” she says. “Since those guidelines are always evolving, we rely on these officers to keep us abreast of important changes. Our hygiene trainers and mentors, as well as other professionals, ensure all of our hygienists follow clinical guidelines in order to provide great and safe care.” My hope is that, as you are reading this, the worst of Coronavirus has passed. And that dental professionals continue to show their patients exactly what safe dental care should look like.
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Biodentine
®
REGENERATE & SAVE TEETH
Pediatrics
Endodontics
Restorative
SAVE THE ROOT, SAVE THE TOOTH: ∙ Effective bioceramics for regenerative endodontics1 ∙ Proven clinical results2 ∙ Hydrophilic: can set in moisture ∙ Uni-dose: no cross contamination 1: Ninnita Wongwatanasanti, DDS, Jeeraphat Jantarat, PhD, Hathaitip Sritanaudomchai, PhD, and KennethM. Hargreaves, PhD. Effect of Bioceramic Materials on Proliferation and Odontoblast Differentiation of Human Stem Cells from the Apical Papilla. JOE Journal of Endodontics. August 2018. 2: Bioactivity of Biodentine®: A Ca3SiO5-based Dentin Substitute. Oral session, IADR Congress, Barcelona 2010. Strassler H. et al.: Compressive Deflection of Composite Layered on Biodentine and Two Bases. Poster, AADR, Tampa 2012. 2: K. Bentley, S. Janyavula, D. Cakir, P. Beck, L.C. Ramp, J.O. Burgess. «Mechanical and Physical Properties of Vital Materials». School of Dentistry, University of Alabama at Birmingham, Birmingham, AL.
For more information, visit septodontusa.com/products/biodentine
800-872-8305 ∙ septodontusa.com From the manufacturers of Septocaine anesthetics ∙ materials ∙ endodontics ∙ infection control ®
SIMPLICITY IN 1 SHADE + X-TRA x-tra low shrinkage x-tra depth of cure x-tra high biocompatibility
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omnichromatic
Single-shade restorative to simplify the procedure, save time and reduce inventory Only one omni-chromatic shade: no guess work and no more wasted shades 4 mm depth of cure – saves time Easy to polish, highly stain resistant with a high gloss Exceptional longevity with low initial shrinkage of only 1.25% 100% BPA-Free and no classic monomers for superior biocompatibility Final Result
Before Light Cure
Final Result
Before Light Cure
Final Result
C4
A2
Before Light Cure
B1
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SINGLE-SHADE OMNI-CHROMATIC NANO-ORMOCER RESTORATIVE
