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Dentistry Today Thereâ&#x20AC;&#x2122;s a reason why so many dentists are choosing to join a DSO

MAY/JUNE . 2019

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May/June . 2019

Editor’s Note

The Value of DSOs............................................................................... 4

Developmental Modalities and Team Coaching

Could your team development measures be hurting morale?................. 6

Dentistry Today

There’s a reason why so many dentists are choosing to join a DSO........ 12

American Dental Partners, Inc., Maplewood Metro Dentalcare .................... 14 DecisionOne Dental Partners, Acierno Family Dentistry ............................... 16 Pacific Dental Services, Henderson Modern Dentistry .................... 20 Marquee Dental Partners, Embassy Hillsboro Village ............................ 24 Mortenson Family Dental – Shelbyville, Kentucky location ..................... 27

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

Face Masks Selecting comfortable, great-fitting masks for the dental team can be key in ensuring that they consistently wear them........... 32

Gloves Gloves today are thinner – and offer greater durability – than their predecessors........................................................................ 36

Periodontal Disease Understanding the risks of periodontal disease can motivate patients to adhere to a good oral homecare routine............. 38

Compliance and Infection Control in the Dental Lab.................................................................. 44 Endodontics

Better technology means more accurate diagnosis and treatment......... 48

Changing the Narrative

Getting non-insured patients engaged in your group practice.............. 52

Why Nice People Start Turf Wars .......................... 56 News............................................................................................. 58

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

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

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

Efficiency In Group Practice is published six times a year by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2019 by Share Moving Media All rights reserved. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publishers. Publishers cannot accept responsibility for the correctness of an opinion expressed by contributing authors.

ISSUE 3 • 2019 : DentalGroupPractice.com

Editor’s Note

The Value of DSOs

Laura Thill

It’s no surprise that more and more dental professionals are joining a dental service organization. Many solo practitioners are tired of dealing with the day-to-day administrative responsibilities that take them away from practicing dentistry. They miss a work-life balance. Indeed, there’s much to be said for being able to leave the office at the end of the day, without having to worry about administrative responsibilities. For this issue of EGP, we asked several DSO-affiliated practices about common concerns dentists raise when it comes to running a practice. Implementing new technology, addressing the oral-systemic health connection and working with the growing number of young dental professionals entering the industry are high on their list. As William Johnson, DDS, a general practitioner at Metro Dentalcare (Minneapolis and St. Paul, Minnestoa), an affiliate of American Dental Partners, Inc., points out, “Metro Dentalcare is very interested in seeing its team members pursue new technologies and achieve a work/life balance, which I believe many millennials value. Belonging to a dental service organization makes it possible for us to accomplish this.” Patients who seek dental care at DSO-affiliated practices are often rewarded with affordable, quality care. DSO-supported clinicians often accept benefit plans, they are conveniently located and they offer more convenient hours, notes Danielle Moody, senior manager of practice management and medical integration for Pacific Dental Services. Jacob Masters, DMD, who practices at Mortenson Dental Partners’ (MDP) Shelbyville, Kentucky location, concurs. “As a company, we try to provide as many services inhouse as possible, knowing our patients value seeing the same practitioner and developing consistent relationships,” he says. Additionally, DSO support enables dentists to broaden their scope of treatment. “Instead of just treating teeth, we have shifted our focus to treating the whole body,” says Michael Acierno, DDS, co-founder and chief medical officer of Acierno Family Dentistry, DecisionOne Dental Partners (Chicago, Illinois). That includes taking patients’ blood pressure and screening for sleep apnea, diabetes and several other health risk factors. For Mark (Jay) Ruark, II, DMD, Marquee Dental Partners, Embassy Hillsboro Village office (Nashville, Tennessee), belonging to a dental service organization affords him the best of two worlds. He can make his practice his own, and at the same time, he benefits from the support that Marquee Dental Partners offers. All that said, the dentists we surveyed agree: No matter how large or small a dental practice is, what matters most is that patients are treated with the best possible care.

Implementing new technology, addressing the oral-systemic health connection and working with the growing number of young dental professionals entering the industry are high on their list.

Efficiency In Group Practice : ISSUE 3 • 2019

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Practice Points

Developmental Modalities and Team Coaching Could your team development measures be hurting morale?

Knowing where Chicago is won’t help me get there unless I also know where I am relative to Chicago. Am I trying to get there from Charlotte or Boston? It seems apparent that we need to know where we are and where we want to be in order to get there. Yet, when it comes to team development, a surprising number of organizations look for shortcuts, without clearly thinking about where they stand. In the end, this shortcut can be costly in terms of time, money and employee morale.

By Kristine Berry, RDH, MSEC Kristine Berry is an international speaker and executive coach, specializing in enhancing group practices. If you are looking for a speaker or coach, she invites you to email her at kristine@kristineberry.com or visit her website www.kristineberry.com.

Over the past decade, the popularity of team building or team appreciation has grown exponentially. The terms team facilitation, team building, team consulting, team coaching and team training are often used interchangeably, and many dental groups are eager to capitalize on the perceived benefits. But they might not know what they are honestly getting. Some succeed despite themselves. Some fail when they didn’t have to. Most employees and outcomes suffer more than they should have. In this article, we will discuss: • Clear distinctions between five team developmental modalities, with the benefits and limitations of each. • Team coaching and literature insights.

Efficiency In Group Practice : ISSUE 3 • 2019

Team development modalities There are a variety of different ways of developing your groups or teams, including: • Team facilitation. • Team training. • Team building. • Team consulting. • Team coaching. Each of these approaches – or modalities – has value, and each is appropriate in certain circumstances. It’s important to be clear about which modality you’re using at any given moment, as well as the outcomes you’re likely to achieve with that approach. It is also vital to understand the distinctions between the various modalities and what each modality can achieve. The following is an example of the five team modalities:

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Practice Points

Modality No. 1: Team facilitation •A pproach. Active guidance and management of a specified method, process or tool during a planned meeting or work session. • Facilitator responsibility. Owning and implementing the method, process or tool effectively to drive the team’s desired results. • What it sounds like. “The next step in this process is writing a systems checklist. I’ll remind you of the guidelines and lead you through it.” • Direct outcomes. Achievement of a specific team goal or deliverable (i.e., case acceptance system). • Back at the office impact. The team leader and members may adopt useful facilitator behaviors and/or a new method, process or tool.

It’s important to be clear about which modality you’re using at any given moment, as well as the outcomes you’re likely to achieve with that approach. Modality No. 2: Team training •A pproach. Learning a set curriculum delivered through reading, teaching and exercises. • Trainer responsibility. Accurately and effectively communicating subject matter; providing expertise in a given subject area (i.e., hygiene retention). • What it sounds like. “Now that you’ve learned about building value in your hygiene department, split up into pairs and discuss how you can incorporate these tools and strategies in your offices.” • Direct outcomes. Increased knowledge and acquisition of new skills. • Back at the office impact. Learned skills may be applied to the day-to-day duties and responsibilities of the office and/or a new system for the office. 8

Efficiency In Group Practice : ISSUE 3 • 2019

Modality No. 3: Team building • Approach. Games, simulations, role play and other structured group experiences delivered during special event or meeting. • Team builder responsibility. Structuring and leading an engaging, bonding experience for the team. • What it sounds like. “Everyone grab a blindfold, a piece of rope and a rubber ball.” • Direct outcomes. Greater team spirit, cohesion and personal trust. • Back at the office impact. Team spirit, trust and cohesion may have a positive impact on team member interactions. Modality No. 4: Team consulting • Approach. Assessment or survey followed by recommendations and expert direction or advisory support. • Consultant responsibility. Providing relevant and useful analysis and advice. • What it sounds like. “You’re missing some critical metrics and systems in your practice. I recommend you do A, B and C...” • Direct outcomes. Expertise and directives of what needs to be accomplished to achieve the desired outcome. • Back at the office impact. Steps and strategies the team might commit to and implement to facilitate changes in their workflow. Modality No. 5: Team coaching • Approach. Real-time interventions during regular team meetings and work sessions. • Coach responsibility. Sharing in-the-moment observations and questions that expand team awareness and the potential for change. • What it sounds like. “Over the past five minutes, what have you noticed about the team’s approach to X? What would you like to do differently going forward?” • Direct outcomes. Immediate improvements in awareness, skills and effectiveness. • Back at the office impact. Positive changes in individual and team performance can be observed and reinforced right away.

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Practice Points

A closer look at team coaching Team coaching, as defined above, is a relatively recent concept in dentistry. It is growing in popularity for a variety of reasons. The most cited reason is that it supports sustainable implementation and accountability, because it can be done in real time while doing real work. Then, organizations have less and less time to shut down practice locations and go off-site for traditional team events, and budgets are tight. Many consumers of team development programs (an amalgam of personal development plans and the business objectives) not only want to provide learning opportunities for their employees, they also seek support through the implementation of backin-the-office change to achieve sustainable results. Recently, while coaching a team, I noted their lateness in beginning their morning huddle. The pattern of

lateness is the behavior. Moreover, I noticed no one said anything about it. You may ask yourself, “Well, has the team been trained on how to conduct a morning huddle?” Yes. “Does the team understand the meaning of having a morning huddle?” Yes. “Are there checklists and standard operating procedures in place to follow regarding the process of a morning huddle?” Yes. Training, facilitation (role play), consulting (huddle system or process) and team building (agreement to have a huddle) apparently had been addressed for this team. Yet, when a team member or a doctor walked in late, no one apologized and the huddle started all over again. I sensed a feeling of discomfort by the team members who were there on time; the huddle started late, it was choppy up front, team members’ time was being wasted, and there was a general sense of frustration. I asked the team about the norms around this behavior. When I explored this question with them, I found they had the following beliefs regarding lateness: • Being on time doesn’t matter. No one cares, no one calls anyone out and no one is held accountable. • The late team member and doctor told me, “My time is more important than theirs.” These assumptions drive the behaviors that create the outcome: unproductive or ineffective huddles and beginning the day with team members feeling disrespected and frustrated. A negative feeling was palpable throughout the day and the cost to the practice could be seen in terms of: • Higher turnover rate of valued employees. • Decreased morale and motivation, resulting in lower productivity. • Excessive owner/managerial time devoted to addressing employee distress over why it was okay for others to be late.

Efficiency In Group Practice : ISSUE 3 • 2019

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As a team coach, I don’t believe this team needed another webinar or training on the mechanics of a huddle. Yet, there was an opportunity to coach the team leader and owner so they would have the outcome they desired: respectful conduct and accountable performance – in other words, a fully present, engaged and productive morning huddle. My experience having coached hundreds of teams has shown me that teams develop habitual behaviors and norms, which may undermine individual and collective change. Hence, when transformation is the goal, an integrated team development approach that incorporates

Real transformation requires the team to do more than acquire useful tools, learn new systems or skills, or obtain specific short-term results. team coaching offers the unmatched potential to guide the team where it needs to go. Team coaching as a core practice, supported by other modalities that provide the necessary tools, skills and methods within a framework, serves as an essential driver of a team’s success.

Team coaching and team literature insights In the academic world of team coaching, the following are the thought leaders: Richard Hackman, Ruth Wageman, Peter Hawkins, David Clutterbuck, Christine Thornton, Patrick Lencioni, Alex Caillet and Amy Yeager. Their published works speculate that team

coaching is 30 years behind individual coaching in definitions, training and research. The research related to skill acquisition of coaches suggests a lack in the developmental pathway from individual coach training and experience to a masterful team coach. It seems that most coaches just transfer the skills they use to coach individuals, add a dash of facilitation (facilocoaching, as I call it) or team building, and wing it. Key insights from peer review articles have identified that it’s the rare team coach who starts from a deep understanding of team process and dynamics, complex adaptive systems, complexity theory, a background in interpersonal group dynamics or group-based dialogue. Additionally, coaches minimally trained in team development theories rarely reveal to their audience or client whether they are wearing the hat of a team coach, facilitator, consultant or trainer. Of the 130+ team coaching models identified in the research, the four academic team coaching studies indicate that team coaching has a positive impact on a team’s performance (outcomes), motivation (the effort people invest), innovation, increasing the level of trust and respect (safety) and increasing the level of skills and knowledge within a team.

Summary Each of the five team development modalities is very helpful in achieving specific team outcomes. But, if the appropriate modality is not applied, the results won’t be as successful. Problems arise when there’s a disconnect between the result you want for your team and the modalities being used to achieve it. Arguably, the most challenging type of outcome to achieve is transformative and sustainable change. Real transformation requires the team to do more than acquire useful tools, learn new systems or skills, or obtain specific short-term results. Team coaching is a way to blend the development and training of teams with a consistent drive toward real, meaningful and sustainable change objectives.

References

1. Brown, S. W., & Grant, A. M. (2010). From Grow to Group: theoretical issues and a practical model for group coaching in organizations. Coaching: An International Journal of Theory, Research and Practice, 30-45. 2. Caillet, A., & Yeager, A. (n.d.). Team Coaching: A Deep Dive. 2018 Institute of Coaching Conference Presentation. Boston, MA. 3. Peters, J., & Carr, C. (2013). Team effectiveness and team coaching literature review. Coaching: An International Journal of Theory, Research and Practice, 116-136. 4. Salas, C. E., & Rosen, M. (2008). On Teams, teamwork, and team performance: Discoveries and development. Human Factors, 50 (3). 5. What so experienced team coaches do? Current practice in Australia and New Zealand. (2019, February). International Journal of Evidence based Coaching and Mentoring.

ISSUE 3 • 2019 : DentalGroupPractice.com 11

Dentistry Today There’s a reason why so many dentists are choosing to join a DSO

Support and training for dentists and staff and greater access to dental care for patients are just a couple of reasons why more and more dental professionals are joining a dental service organization. Being part of a group has offered greater purchasing efficiency and staffing support, says one dentist. Another applauds the discount pricing on labs and supplies, which have By Laura Thill enabled his practice to reduce overhead and increase profitability. In addition, DSOs generally provide good medical insurance and stock ownership options, enabling dental owners to offer their staff higher wages and better benefits. Not only are some solo practitioners tired of dealing with the day-to-day administrative responsibilities that take them away from practicing dentistry, they miss a work-life balance. “I can leave the office at the end of the day and spend time with my family, without having to worry about many of the daily office responsibilities,” says one dentist. Efficiency in Group Practice profiled several DSO-affiliated dental practices about a number of issues, including implementing new technology, addressing the oral-systemic health connection and working with the growing number of young dental professionals entering the industry. Here’s what they had to say: 12

Efficiency In Group Practice : ISSUE 3 • 2019

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Dentistry Today

American Dental Partners, Inc., Maplewood Metro Dentalcare Metro Dentalcare is an affiliate of American Dental Partners, Inc., a national company that provides management support to group practices. Metro Dentalcare is comprised of 50 dental practices throughout Minneapolis and St. Paul, Minnesota William Johnson, DDS, practices at Maplewood Metro Dentalcare, a general dentistry office that is home to two dentists, six hygienists, a couple of licensed assistants and a front-desk staff member. “Being part of a group has given our office greater access to patients, as well as offered us greater purchasing efficiency and staffing support,” says Johnson. “We have been able to add more staff members and more advanced technology, enabling us to provide excellent patient care.” In turn, patients have experienced not only optimal treatment but better customer service, he points out. “Our patients can visit a conveniently located office, and they have access to more on-site services,” he explains. Efficiency in Group Practice: How does your practice implement new technology efficiently and effectively? William Johnson, DDS: As a group, we research new technology and work together to find the best results and most efficient equipment. We look at outcomes-based research and pilot new materials to ensure that our technology meets the needs of our doctors, our team and our patients. It’s especially helpful to have so many brains in the game. We benefit from a lot of knowledge, feedback and information being shared by so many team members in the group. A unique benefit of our practices is that we are accredited by the Accreditation Association for Ambulatory Health Care (AAAHC). This means that we are constantly reviewing protocols and best practices around risk management, environmental safety, patient rights, clinical records and other areas of concern. Efficiency in Group Practice: As more millennials enter the dental industry, how has this impacted your practice? 14

Efficiency In Group Practice : ISSUE 3 • 2019

William Johnson, DDS: Metro Dentalcare is very interested in seeing its team members pursue new technologies and achieve a work/life balance, which I believe many millennials value. Belonging to a dental service organization makes it possible for us to accomplish this. For one, our clinicians needn’t worry about addressing business and management responsibilities. They can focus on practicing dentistry and providing great patient care. And they have more time to pursue activities outside of work. For my part, I feel like I can plan and schedule treatments so as to meet the best interests of my patients. Efficiency in Group Practice: We hear more and more about the connection between oral and physical health and the need for dentists to take a holistic approach to patient care. How has this impacted the way your dental professionals work with patients? William Johnson, DDS: At Metro Dentalcare, we use a comprehensive, whole-body approach to bridge the gap between medical and dental, and strive to educate our patients on the entire picture of oral health. Our doctors and hygienists focus on the clinical aspects of dentistry and treat patients for what they present with that day. We take time to discuss our patients’ health needs, as well as alternatives for care. As part of a dental group, we have access to more information and diagnostic tools to better evaluate our patients. Efficiency in Group Practice: In your experience, what does the growing DSO market mean for traditional solo practices? William Johnson, DDS: Both solo practices and group practices have their place in the dental industry. That said, I believe patients as a whole will benefit from greater access to care (i.e., multiple locations from which to choose, expanded office hours, etc.) that larger groups can offer.

Dentistry Today

DecisionOne Dental Partners, Acierno Family Dentistry Acierno Family Dentistry, a general dentistry office, is one of 26 offices that comprise DecisionOne Dental Partners. Located in the Edison Park neighborhood of Chicago, Illinois, the office is home to three dentists, five hygienists, seven dental assistants and five front-office team members. “Being part of a group provides our doctors with numerous benefits,” says co-founder and chief medical officer Michael Acierno, DDS. “As part of a group, Acierno Family Dentistry is supported on all back-end business items, enabling our team members to focus on what matters most: providing patients with exceptional care. At the same time, the group offers our doctors mentorship and educational opportunities to help them grow professionally.” 16

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Dentistry in 2019 is changing drastically due to a number of factors. For one, the cost of a dental education is higher than ever, and it is continuing to rise. In addition, the rising costs of technology and dental materials are making it increasingly difficult to purchase a practice.

“All 26 locations are community-based, which means our primary focus is on customer service and excellent patient care,” says Acierno. “We want our patients to be comfortable and to feel like we are their advocates.” That means addressing patients’ needs from the time they enter the office to the time they complete their visit, he notes. “Our front office staff work hard to provide patients with accurate treatment plans; they also work closely with insurance companies to ensure patients receive their full benefits.” Efficiency in Group Practice: How does your practice implement new technology efficiently and effectively?

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Dentistry Today

Michael Acierno, DDS: Oral cancer is becoming one of the most frequent cancers in the world, and catching it early is crucial. Fortunately, there is a lot of great technology in the dental field right now that allows us as clinicians to do more for our patients than ever before. We have placed a Velscope in every one of our practices. This oral cancer screening tool allows dentists to see changes in tissue that cannot be seen with the human eye. Being a part of a group has enabled us to work with the manufacturer to ensure not only that each of our offices has the technology, but that everyone is properly trained to use it. Several of my patients have benefited, as we have been able to catch this devastating disease early.

dental materials are making it increasingly difficult to purchase a practice. For these reasons, a higher number of graduating dentists are less likely to practice on their own, and more likely to join a group. DecisionOne Dental Partners understands this. We have tried to create a model that meets these demands – a model where doctors can have ownership in our group while enjoying the benefits of a support organization. This has worked really well for us, and our doctor retention rate is over 90 percent.

Efficiency in Group Practice: We hear more and more about the connection between oral and physical health and the need for dentists to take a holistic approach to patient care. How has this impacted the Efficiency in Group Practice: As more millennials way your dental professionals work with patients? enter the dental industry, how has this impacted Michael Acierno, DDS: A majority of dental patients see your practice? their dentist more frequently than they see their physiMichael Acierno, DDS: Dentistry in 2019 is changing cians. We understand this. Instead of just treating teeth, drastically due to a number of factors. For one, the cost of we have shifted our focus to treating the whole body. We a dental education is higher than ever, and it is continuing now take all of our patients’ blood pressure and recomto rise. In addition, the rising costs of technology and mend that those with high readings see their physician. We also screen for sleep apnea, diabetes and several other health A majority of dental patients see their dentist more frequently risk factors that patients need to be than they see their physicians. We understand this. Instead of aware of.

just treating teeth, we have shifted our focus to treating the whole body. We now take all of our patients’ blood pressure and recommend that those with high readings see their physician. We also screen for sleep apnea, diabetes and several other health risk factors that patients need to be aware of.

Efficiency In Group Practice : ISSUE 3 • 2019

Efficiency in Group Practice: In your experience, what does the growing DSO market mean for traditional solo practices? Michael Acierno, DDS: While there will always be a place for private practices in dentistry, group practices are going to continue to grow in popularity. As the expenses of the dental field continue to increase, those doctors that want to own a solo practice will need to be prepared to spend a lot of time and energy focusing on the business side of the practice. At the end of the day, whether an office is part of a DSO or is a solo practice, the only thing that really matters is that patients are treated with exceptional care and customer service.

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Dentistry Today

Pacific Dental Services, Henderson Modern Dentistry Henderson Modern Dentistry, a practice supported by Pacific Dental Services®, is comprised of three offices: Henderson Medical Group, Henderson Modern Dentistry and Henderson Kids’ Dentistry and Orthodontics. The practice is home to a total of 23 dentists, hygienists and staff, and offers a range of services, from general dentistry and hygiene to periodontics, oral surgery, endodontics, pediatric dentistry and orthodontics. “Dental support organizations, or DSOs, provide the support dentists want and need,” says Danielle Moody, senior manager of practice management and medical 20

Efficiency In Group Practice : ISSUE 3 • 2019

integration for Pacific Dental Services. “A team of industry experts in marketing, billing, maintenance, payroll, etc. support us 24/7 with a wealth of administrative knowledge and resources.” This frees up clinicians to focus on patient care, she adds. “Because these clinicians are part of a larger team, they can collaborate with other clinicians on cases, patient issues and best practices. The practice team has access to training and advancement opportunities, as well as benefits not usually available at traditional private practices, such as vacation time, 401(k) opportunities, health coverage, etc.”

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Patients benefit as well, with affordable, quality care, Moody points out. “Supported clinicians often accept benefit plans, they are conveniently located and they offer more convenient hours. Offices like those supported by PDS® offer patients modern care, including digital radiography, electronic health records and same-day dentistry, as well as a team of in-house specialists, from pediatric dentists to periodontists and a general physician.” Indeed, comprehensive and quality care is one of the values patients find most appealing about PDS-supported offices, notes Moody. “We pride ourselves with creating the Perfect Patient Experience® (PPE®). It starts with an authentic and welcoming connection on the telephone,

“Supported clinicians often accept benefit plans, they are conveniently located and they offer more convenient hours. Offices like those supported by PDS® offer patients modern care, including digital radiography, electronic health records and same-day dentistry, as well as a team of in-house specialists, from pediatric dentists to periodontists and a general physician.”

being greeted with a smile, connecting on a higher level with their healthcare provider and knowing we are there to meet their dental and medical needs. When patients have a dental issue that requires a specialist, they are able to take care of the problem without being referred to another office. Their records and information stay within the same office, creating an environment for the general dentist and specialist to collaborate on an individualized treatment plan.” And patients appreciate that PDS-supported practices accept most dental and medical insurances, making their healthcare more affordable, she adds. “Our approach to accessibility and quality care bring exceptional value to our supported offices.” ISSUE 3 • 2019 : DentalGroupPractice.com 21

Dentistry Today

risk of cardiovascular events before they happen. Specialized technology equips dentists for oral cancer screenings with better visibility than the human eye can detect. The technology we have in each practice enables our supported clinicians to educate their patients, ultimately giving people the tools to be in charge of their healthcare. Efficiency in Group Practice: As more millennials enter the dental industry, how has this impacted your practice? Danielle Moody, senior manager of practice management and medical integration: Being a part of a DSO has helped us attract millennials, as well as Generation Z candidates. They are looking for stable employment, which is something PDS-supported practices can “ As oral health care providers, our supported offer. We find it’s very important clinicians are often the first contact patients have that we stay current in the way we with an integrated healthcare system. Cooperation, communicate and interact, lest this group perceive us as being outdated collaboration and integration of healthcare and disingenuous. For instance, between dentists and primary care physicians we appreciate that video calls have can only improve the health and lives of patients. become much more common today. Pacific Dental Services values indiAnd when patients understand their personal risk viduality, and this carries over to associated with oral disease, they can take steps to our approach to recruiting younger better control their health.” dental professionals. It seems to be working: In December 2018, Pacific Efficiency in Group Practice: How does your practice Dental Services surpassed 700 supported dental offices. implement new technology efficiently and effectively? Danielle Moody, senior manager of practice manageEfficiency in Group Practice: We hear more and more ment and medical integration for Pacific Dental about the connection between oral and physical Services: Embracing and utilizing the latest and greatest health and the need for dentists to take a holistic technology in dentistry and medicine has helped set approach to patient care. How has this impacted the us apart from other healthcare providers. Using these way your dental professionals work with patients? resources efficiently, we have empowered our supported Danielle Moody, senior manager of practice clinicians and enabled them to prevent disease, instead management and medical integration: PDS-supof simply treating the symptoms. Simple ultrasounds ported clinicians are aware that dentists have an opporcan provide information to clinicians about a patient’s tunity to make a huge difference in the general health 22

Efficiency In Group Practice : ISSUE 3 • 2019

The EPA Regulation is 14 months away Is your group prepared? Get a free amalgam separator when you lock in the annual recycling rate for 3 or 5 years. An $850 value.2

Your DSO has a choice to make: Get a FREE1 amalgam separator from DRNA. OR Purchase an amalgam separator for more than $1,100.3 Place your order with DRNA to receive FREE amalgam separators for members of your organization by July 31, 2019, and we will ship no later than March 31, 2020. Ask any of our prestigious customers why they prefer DRNA for their dental waste management needs.

Call DRNA at 800-360-1001 ext. 2 or visit www.DRNA.com to sign up and receive your separator at no cost from DRNA. Receive a free unit when you sign a 3- or 5-year recycling agreement at $500/year for the BU10-5 and $750/year for the BU10-30, inclusive of all costs. Retail price of the unit has, from time to time, been less because of promotions. The EPA estimates that the average cost of an amalgam separator is $1,181.40. Environmental Protection Agency. Effluent Limitations Guidelines and Standards for the Dental Category. Washington, D.C: U.S. Table 9-2, Pg 9-9.

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of their patients, beyond simply treating the oral cavity. There is a strong correlation between disease of the oral cavity and systemic health issues, such as coronary artery disease, strokes, diabetes and even Alzheimer’s disease. As oral health care providers, our supported clinicians are often the first contact patients have with an integrated healthcare system. Cooperation, collaboration and integration of healthcare between dentists and primary care physicians can only improve the health and lives of patients. And when patients understand their personal risk associated with oral disease, they can take steps to better control their health. At Pacific Dental Services, the DSO platform empowers us to move faster and accomplish more in a shorter period of time, all of which translates into higher quality care for the patients that we serve. We rely on the latest technology, the most up-to-date research and the collaboration of the best minds in healthcare. Our supported clinicians have an opportunity to collaborate with one another, and leverage resources and expertise to ensure they provide patients with the highest level of care and the best possible experience.

4/11/19 4:09 PM

Efficiency in Group Practice: In your experience, what does the growing DSO market mean for traditional solo practices? Danielle Moody, senior manager of practice management and medical integration: There will always be room in the market for solo practices, small group practices, DSOs and more. When you look at the population of potential patients versus the number of practicing dentists, there is still plenty of opportunity for more dental offices throughout the nation. The solo practice dentist and the DSO-supported dentist usually have the same goal: to provide the best possible care for the patients they treat. The platform we have created allows practice owners and clinicians to focus on patient care while a support team takes care of the business concerns, which can be a distraction from clinical excellence. We understand that the opportunity to serve patients remains vast and plentiful for everyone. Considering the resources DSOs invest in patient education, marketing and new patient acquisitions, I’d say they’re helping to broaden the opportunities and increase the pie for everyone. ISSUE 3 • 2019 : DentalGroupPractice.com 23

Dentistry Today

Marquee Dental Partners, Embassy Hillsboro Village One of 28 practices that comprise Marquee Dental Partners, the Embassy Hillsboro Village office, located in Nashville, Tennessee, is home to Mark (Jay) Ruark, II, DMD, and his team of one hygienist, three dental assistants and three administrative employees. For Ruark, belonging to a dental service organization affords him the best of two worlds. As with solo practices, he continues to “make my practice my own,” he says. At the same time, he benefits from the support that Marquee Dental Partners offers. “Marquee Dental Partners has my back and I, in turn, have theirs,” he explains. “There is mutual respect and appreciation for what each party brings to the table.” 24

Efficiency In Group Practice : ISSUE 3 • 2019

As a result, Ruark enjoys a solid work-life balance. “I can leave the office at the end of the day, spend time with my family or think about ways to grow my practice, without having to worry about many of the daily office responsibilities,” he says. “That may sound cliché, however I can speak from experience. I have considered acquiring various dental practices, and it appears the top reasons dentists want to sell their practice are because they are tired of dealing with the day-to-day administrative responsibilities that take them away from practicing dentistry, and they miss having an experienced central support system.

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“Marquee Dental Partners supports both my office staff and me personally,” Ruark continues. “At any time, I can text my CEO, COO, dental director or one of the dentists in my DSO, ask a question and ALWAYS get a response. This simple, direct line of communication saves me so much time and energy. In fact, I am friends with my CEO. In addition to our professional meetings, we like to just hang out and chat. How cool is that? We both want the same results for the company as a whole, and we are approaching our mutual goals together. How many dentists in private practice have a partner they can trust to discuss best practices for business models and patient care? Additionally, belonging to a bigger organization provides tremendous benefits for my practice when it comes to negotiated fees on supplies, labs, service, etc. Marquee Dental Partners also takes care of all the marketing and attracts new patients to my practice. Compare that to the average private practice, which spends 20-30 percent of its revenue on marketing. My

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“ At any time, I can text my CEO, COO, dental director or one of the dentists in my DSO, ask a question and ALWAYS get a response. This simple, direct line of communication saves me so much time and energy.” grandfather, who at one time had a private practice, and my aunt, who currently runs a practice, can’t comprehend benefits such as these.” Ruark’s staff also feels better supported and more confident working within a DSO, he notes. “The benefits afforded to them can’t be compared with most private practices,” he says. “They were hired and trained by Marquee Dental Partners, which is an amazing advantage. That leaves us to focus our attention on patients, providing them with quality personal care and the best products available on the market. Our patients, in turn, appreciate ISSUE 3 • 2019 : DentalGroupPractice.com 25

Dentistry Today

that most of their dental work – from root canal to oral surgery – can be completed onsite.” Efficiency in Group Practice: How does your practice implement new technology efficiently and effectively? Mark (Jay) Ruark, II, DMD: My office utilizes updated technology, including digital radiography, PAN, Ceph and CEREC. Marquee Dental Partners provides me with the tools I need to be a great dentist. There isn’t a day that goes by when I go home and question my patient care. I give my patients my all and my best. That said, I also acknowledge my limits and refer out the care my office cannot provide. This is something Marquee Dental Partners not only supports, but champions.

old brother and his best friend are both pursuing careers as dentists, and I strongly encourage them to start out with a DSO. Not only would they receive competitive compensation, they would be supported and mentored in a way that is not possible in private practice. Efficiency in Group Practice: We hear more and more about the connection between oral and physical health and the need for dentists to take a holistic approach to patient care. How has this impacted the way your dental professionals work with patients? Mark (Jay) Ruark, II, DMD: My mom is the healthiest person I know and as holistic as it gets: yoga this, yoga that, breathe, downward dog, upward dog, pray, etc. The only sugar in her diet is the occasional red wine when she hosts amazing organic meals. She herself worked in the dental field. Her father was her dentist and boss, her sister-in-law was her orthodontist, and after my grandfather retired, I became her dentist. She presents me with holistic questions all the time. And while some of her methods have not been scientifically proven to prevent or cure anything, they’ve never had an adverse effect. At the same time, they haven’t prevented her from needing several crowns and multiple root canals.

“ I think the key for solo practitioners is to understand that every DSO is different. If they evaluate their options and feel that partnering with a DSO is in their best interest, they really need to look for the right fit.” Efficiency in Group Practice: As more millennials enter the dental industry, how has this impacted your practice? Mark (Jay) Ruark, II, DMD: Nashville is usually rated among the top three fastest growing cities and is an attractive place to live for millennials. In fact, when I graduated from dental school in 2011, Nashville was one of my top choices; and that was before the boom. At that time, I wasn’t able to find a position there, so I took a job with a DSO in another city in order to provide for my family. But, when another DSO offered me the opportunity to come to Nashville in 2012, I immediately accepted and never looked back. The numbers say that attending dental school is more expensive than medical school, especially for out-of-state students like myself. Working for a group like Marquee Dental Partners provides me more-than-competitive compensation for my hard work. And, their support, as I’ve mentioned, is key. My 18-year 26

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Efficiency in Group Practice: In your experience, what does the growing DSO market mean for traditional solo practices? Mark (Jay) Ruark, II, DMD: The immediate financial advantages that DSOs bring to the table, from group rates on vendor fees and services to reduced rates for lab services, are significant. I think the key for solo practitioners is to understand that every DSO is different. If they evaluate their options and feel that partnering with a DSO is in their best interest, they really need to look for the right fit. Marquee is not the right fit for every practice, and that’s okay. Regardless of what solo practitioners decide to do, I think they should educate themselves on the growing DSO market and really understand the pros and cons of partnering before dismissing that option.

Mortenson Family Dental – Shelbyville, Kentucky location One of 145 practices that comprise Mortenson Dental Partners (MDP), the Shelbyville, Kentucky location is home to Jacob Masters, DMD, and his team of three hygienists, three dental assistants and two frontdesk staff members. Since joining MDP five years ago, Masters and his staff have benefited from guidance, brand recognition and more. “Working within a dental service organization has enabled us to be a part of larger network that offers support, guidance and even addresses administrative needs, such as hiring new staff or purchasing supplies,” says Masters. “MDP has helped us get bulk discount pricing on labs and supplies, enabling us to reduce our overhead and increase our profitability. They have also extended such benefits as employee medical insurance and stock ownership.” In turn, he has been able to offer his staff higher wages, better benefits and retirement opportunities. For patients, this has meant lower costs and better care. “Through consistent auditing processes, implementation of equipment/new technology and collaboration with groups within the DSO, such as the clinical committee, our patients can receive consistent and competent care,” he points out. Masters especially appreciates that MDP values involvement in organized charities. “Every practice within our DSO is encouraged to provide charity services, such as

patient discounts or fundraising through 5K races and raffles,” he explains. “MDP also makes year-round financial donations to multiple organizations via annual projects. The most successful of these projects is an annual whitening fundraiser, where all proceeds are donated to charity. MDP has donated over $1.7 million to charity over the past 20 years through whitening alone.” MDP also organizes a free-extraction charity to patients in need, he adds. Efficiency in Group Practice: How does your practice implement new technology efficiently and effectively? Jacob M. Masters, DMD: Our offices are consistently equipped with digital X-ray sensors, digital panoramic imaging, intraoral cameras, soft tissue lasers, adjunct oral cancer screening devices and electronic health records. As a company, we have been slower to adopt bleeding-edge technologies, such as intraoral scanning and cone beam technology; the current return-on-investment at the average general practice level has not proven to be profitable. However, CBCTs have been regionally placed, allowing practitioners to refer patients to another office for a scan at the same fixed cost to the company. As the applications of CBCT technology and intraoral scanning continue to develop, and as the cost continues to decrease, I see these technologies becoming pieces of standard equipment at each of our offices. ISSUE 3 • 2019 : DentalGroupPractice.com 27

Dentistry Today

There’s no question that technology has enabled us to give our patients a consistent, family-friendly experience and competent care. As a company, we try to provide as many services in-house as possible, knowing our patients value seeing the same practitioner and developing consistent relationships. As such, other offices in our DSO can refer patients internally, offering internal discounts while creating brand loyalty. Access to the Internet has helped patients become better educated and more cost conscious, and they appreciate that our front desk has the tools to provide as much information upfront as possible regarding the cost of the procedures, eliminating any last-minute surprises. Efficiency in Group Practice: As more millennials enter the dental industry, how has this impacted your practice? Jacob M. Masters, DMD: Millennials are, without a doubt, the most technology-adept generation to enter the

to the organization. Our office has seen higher turnover among front-desk staff and dental assistants, leading us to offer higher wages and greater educational opportunities to individuals interested in these positions. MDP, too, emphasizes a better work-life balance, promotes the benefits of ESOP and health insurance and attempts to create a culture that is unique and enjoyable, with shared values, ethics and goals. Efficiency in Group Practice: We hear more and more about the connection between oral and physical health and the need for dentists to take a holistic approach to patient care. How has this impacted the way your dental professionals work with patients? Jacob M. Masters, DMD: At MDP, we place vital importance on collecting a consistent and comprehensive medical history, including medication lists, for all of our patients. This has allowed our providers to better educate patients on oral-systemic connections. In my office, we have had particular success implementing headand-neck exams, including lymph node checks, sleep apnea evaluations, extra-oral soft-tissue exams and taking baseline vitals on new patients. These small steps have, without a doubt, saved lives. From cancer to dangerously high blood pressure, we’ve seen it all. Being a member of a DSO has allowed us to better educate our patients and offer them greater systemic care.

There’s no question that technology has enabled us to give our patients a consistent, family-friendly experience and competent care. As a company, we try to provide as many services in-house as possible, knowing our patients value seeing the same practitioner and developing consistent relationships. workforce, as well as the most susceptible to the disadvantages of social media. They often are more educated, have higher school debt, are unable to utilize their degrees, earn lower wages, are more likely to live with their parents longer and less likely to be home-owners. As a result, they tend to be drawn to educational opportunities and higher incomes that come with working in a DSO. In addition, social media has exposed millennials to multiple workplace cultures. It is easy for companies to advertise new positions, and it’s just as easy for people to apply for them. As it becomes easier for millennials to move from one company to another, it has proven more and more crucial for organizations to focus on building culture and loyalty 28

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Efficiency in Group Practice: In your experience, what does the growing DSO market mean for traditional solo practices? Jacob M. Masters, DMD: From one year to the next, patients invest more and more money in dentistry. The private capital that supports many DSOs increases each year, indicating the dental industry is growing and will continue to do so. Yes, this growth will likely foster new competition; but with the competition comes opportunity. As the dental industry continues to grow, I believe both DSOs and private practitioners will also continue to grow. There is opportunity for all players in the dental industry.

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A Smart Vacuum Is Smart Business As the devastating effects of waste become known, more dental offices are exploring green initiatives, adopting new behaviors, and looking for ways to reduce energy consumption and waste. Infection control methods, mercury-containing dental materials, x-ray systems, and conventional vacuum systems produce the most dental waste according to the Eco-Dentistry Association (EDA). The bigger your group, the higher the environmental and financial cost.

Manufacturers are responding with eco-friendly innovations like the low maintenance PowerVac® G vacuum. It delivers up to 83% energy savings using a sophisticated, on-demand energy management system rather than constant operation. Standard vacuums run at full speed all day, continuously generating pressure. Only a small percentage of that pressure is actually used. The rest gets released through the vacuum relief valve (VRV). It’s an inefficient, energy-sucking process also generating a lot of heat. The heat

Efficiency In Group Practice : ISSUE 3 • 2019

causes excessive equipment wear, compromising reliability and increasing maintenance calls. Then, more energy is required to cool the equipment room. The PowerVac G produces only the pressure that’s needed when it’s needed. You define the optimal vacuum level and a pressure transducer monitors the demand for suction while a variable frequency drive (VFD) adjusts the motor speed to maintain that level. This intelligent computer control means dentists pay only for pressure they actually use and nothing for extra cooling. To say savings are significant is an understatement. At HealthPark Dentistry, a five-dentist office in Ohio, utility costs plummeted by $3,400 in one year. And, the savings go beyond energy. When compared to a dual 2-horsepower wet-ring vacuum system, the PowerVac G saves up to 240,000 gallons of water a year. That’s enough to fill a backyard pool 12 times! Dental practices are exploring the benefits of going green, and smart equipment like the PowerVac G deliver optimal performance that’s environmentally friendly and business smart. Find your projected savings with the interactive savings calculator at midmark.com/savings-calculator.

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Personal Protection Equipment

Face Masks Selecting comfortable, great-fitting masks for the dental team can be key in ensuring that they consistently wear them.

If you believe dentistry to be a low-risk career, think again! According to a 2018 post by Business Insider (https://www.businessinsider.com/most-unhealthy-jobsin-america-2017-4), of the top five professions considered most damaging to one’s health, four are in dentistry, including that of dental hygienist and general dentist. Indeed, when dental professionals neglect to take necessary precautions, they place themselves in harm’s way. For starters, most procedures performed by dental clinicians using ultrasonic scalers, high speed handpieces and air-water syringes are capable of generating contaminated aerosols and splatter, according to Monica Cardona, product manager, personal protective equipment, Crosstex International Inc., a Cantel Medical Company. In fact, the ultrasonic scaler produces more airborne contamination than any other dynamic instrument in dentistry,1 she points out. Furthermore, dental aerosols can travel up to four feet from the work zone2 and remain airborne for up to 30 minutes, placing the dental team at risk for the transmission of infection.3 Some dental professionals may not be aware of the various risks airborne contamination poses to their team, says Cardona, who notes the following: • There is an increased prevalence of respiratory infections among dentists, and the symptoms are associated with the highly contaminated breathing zone in the dental operatory.2 • Based on the average rate of respiration at 16 breaths per minute, a clinician has the potential for 7,680 exposures in a workday.4 • With laser dentistry on the rise, dental professionals are facing a new set of occupational health risks – the potential transmission of disease through the laser plume.5 32

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• Ninety-five percent of laser plume is made up of water, but the remaining five percent contains potentially hazardous bioaerosols, including cellular debris, blood fragments and bacteria.5 “The most effective means to reduce transmission of pathogenic organisms is the use of personal protection equipment (PPE) such as gloves, masks, and eye protection,” says Cardona. “The better educated dental professionals are, the more likely they will be to comply with accepted standards and guidelines,” she adds.

Selecting the right face mask Selecting comfortable, great-fitting masks for the dental team can be key in ensuring that they consistently wear them. In addition, it’s important to understand mask ratings in order to choose the appropriate mask protection level for each procedure performed at the practice. Several mask designs are considered to provide exceptional comfort, according to Cardona: • The Ultra™ Sensitive Earloop Mask with Secure Fit™ Technology from Crosstex, with an extra soft, white hypoallergenic, inner cellulose layer, will not lint, tear or shred, providing ultimate comfort. • Masks with flat ear loops attached to the outside of the mask (as opposed to the inside of the mask) provide a comfortable fit and help eliminate irritation. • Masks free of latex, fiberglass, chemicals, inks and dyes help minimize skin sensitivities. • Masks with anti-fog or fog-free strips on the inner layer block and absorb moisture. They also form a strong seal, preventing the fogging of eyewear while it cushions the nose ridge. • Some masks have unique vapor barriers on the outside layer, further blocking moisture.

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Premium protection for every procedure Contaminants can bypass a mask in several ways. A well-fitting mask offers better protection by minimizing the potential of inhaling airborne contaminants. Secure Fit™ Mask Technology features adjustable nose and chin closures that reduce gapping around the borders of the mask, for a fit that’s unique to you. Did you know? Based on the average rate of respiration at 16 breaths per minute, a clinician has the potential for 7,680 exposures in a workday.1

Request a free sample at crosstex.com/SecureFit

1 “Vital Signs.” Diseases and Conditions Collections: Cardiovascular Diseases, Johns Hopkins Medicine Health Library. hopkinsmedicine.org/healthlibrary/conditions All product names are trademarks of Crosstex International, Inc., a Cantel Medical Company, its affiliates or related companies, unless otherwise noted. © 2019 Crosstex International, Inc. DADV 00830 Rev A 0419

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Aluminum nose and chin closures reduce fogging and gapping.

Personal Protection Equipment Cardona recommends using the following charts to determine the most appropriate mask rating levels for different procedures: Face Mask Tests and User Benefits Tests Fluid Resistance (mm Hg)

Test Description The ability of a face mask’s materials of construction to minimize fluids from traveling through the material and potentially coming into contact with the wearer. Face masks are tested with synthetic blood on a pass/ fail basis at three velocities corresponding to the range of human blood pressure (80, 120, 160 mm Hg). The higher the pressure withstood, the greater the fluid spray and splash resistance. Bacterial BFE is the measure of the percent efficiency at which Filtration a face mask filters bacteria passing through the mask Efficiency by comparing the bacterial inlet concentration to (BFE percent) mask effluent concentration. A higher percentage @ 3.0 µm indicates higher filtration efficiency (i.e., a 95-percent filter efficiency indicates that 95 percent of the aerosolized bacteria was retained by the mask and 5 percent passed through the mask material.) Particulate PFE is the measure of the percent efficiency at which a Filtration Efficiency face mask filters particulate matter passing through the (PFE percent) mask by comparing the particulate inlet concentration @ 0.1 µm to mask effluent concentration. Differential Measures the resistance of mask materials to airflow, Pressure which relates to the breathability of the mask. The values (ΔP mm H2O/cm2) are expressed from 1 to 5; the higher the number, the higher the PFE and BFE. Flammability The rate at which the material burns determines the (flame spread) level of flammability; a minimum of a 3.5 second burn rate is required to pass with a Class 1 rating.

User Benefits Helps reduce potential exposure of the wearer to splash and splatter of blood, body fluids and other potentially infectious materials (OPIM).

Helps reduce wearer exposure to microorganisms.

Helps reduce wearer exposure to airborne biological particles, inorganic dust and debris. Provides measure of comfort and breathability.

Mask materials are flame spread Class 1 rated, meeting FDA recommendations for materials of construction of surgical masks intended for use in operating rooms.

Source: ASTM International (formerly known as American Society for Testing and Materials). Face Mask Material Requirements by ASTM Performance Level Characteristic

LEVEL 1

LEVEL 2

LEVEL 3

Fluid Resistance (mm Hg)

120

160

Bacterial Filtration Efficiency (BFE percent) @ 3.0 µm

≥ 95%

≥ 98%

Particulate Filtration Efficiency (PFE percent) @ 0.1 µm

≥ 95%

≥ 98%

(ΔP breathability) (mm H2O/cm2)

< 4.0

< 5.0

Flammability (flame spread)

Class 1

Differential Pressure

Source: ASTM International (formerly known as American Society for Testing and Materials). 34

Efficiency In Group Practice : ISSUE 3 • 2019

Mask Feature Guide B

A K E

G D OUTSIDE

INSIDE

Outside

Inside

Extra-long, enclosed aluminum nose closure forms a strong seal around nose and cheekbones for maximum protection.

Highest quality meltblown filter media for best filtration efficiency and breathability.

Optional attached wrap-around face shield is optically clear and distortion-free.

The elastic, flat ear loops minimize pressure to the ears and are attached to the outside of the mask to eliminate skin irritation and provide the most comfortable fit.

Extra soft, white hypoallergenic inner cellulose layer for sensitive skin is free of chemicals, inks and dyes; will not lint tear or shred for ultimate comfort.

I J

Fluid resistant, white, spunbond inner layer. Soft, white medical-grade facial tissue inner layer.

Enclosed aluminum chin closure significantly reduces gapping at the sides and bottom of the mask, minimizing the potential of inhaling airborne contaminants.

Unique vapor barrier on the outside layer blocks moisture and prevents fogging.

FogFreeTM strip blocks and absorbs moisture; forms a strong seal preventing fogging of eyewear while it cushions the nose ridge.

Sof-BondTM Ultrasonic Mask assembly ensures strongest construction and highest quality, eliminating holes and defects.

Fluid resistant, spunbond outer layer for maximum protection.

Secure FitTM Earloop Masks

UltraTM Sensitive Mask (White 50/Box GCFCXSSF)

•

UltraTM Sensitive FogFreeTM Mask (White 40/Box GCFCXSFSF)

•

UltraTM Sensitive FogFreeTM Mask with shield (White 25/Box GCPWSSF)

•

Ultra Mask (Blue 50/Box GCFCXUSF)

•

Procedural Mask (Blue, Lavender, Pink 50/Box GCPBLSF, GCPLVSF, GCPPKSF)

•

Isofluid Plus Pure Mask (White 50/Box GPLUSWHSF)

•

Isofluid Mask (Blue, Lavender, Pink 50/Box GCIBLSF, GCILVSF, GCIPKSF)

•

Isofluid FogFree Mask (Blue 40/Box GCICXBSF)

•

Isofluid FogFree Mask with shield (Blue 25/Box GCIPWBSF)

•

TM TM TM TM

TM TM

•

• •

All product names are trademarks of Crosstex International, Inc., a Cantel Medical Company, its affiliates or related companies, unless otherwise noted. © 2019 Crosstex International, Inc. DLIT00836 Rev A 0419

(888) 276-7783

info@crosstex.com

crosstex.com

The right mask for the procedure. Selecting the appropriate mask for a particular procedure is a critical component of your Personal Protective Equipment (PPE) protocol. Although masks may look similar, each mask has notable differences affecting its level of protection. Understanding ASTM performance levels can help ensure your mask will provide appropriate protection to minimize the spread of potentially infectious diseases.

FILTRATION SCALE

MASKENOMICS

UltraTM Mask Line** ≥ 98% 99.8%

99.8%

160 mm Hg

LEVEL 1

≥98%

≥95%

≥98%

≥95%

<5.0

<4.0

Class 1

LEVEL 3

≥98% ≥98% <5.0

Class 1

Procedural Mask Line ≥ 98% 99.8%

ASTM LEVEL 3

99.8%

Root planing & scaling

•

FILTRATION SCALE

≥ 95% 99.8%

ASTM LEVEL 2

•

• • • • •

IsofluidTM Mask Line**

120 mm Hg

Ideal for procedures where moderate • Ideal for procedures where light to 85 - 10 -moderate 100 - 0 amounts of fluid, spray to high amounts of fluid, spray and/or aerosols are produced and/or aerosols are produced. 0 - 100 - 100 - 0 Complex oral surgery • Limited oral surgery Crown preparation • - 100 Endodontics 0 - 69 -0 Implant placement • Prophylaxis Periodontal surgery • - 95 Restoratives/compositives 0 - 26 -0 Use of ultrasonic scalers • Sealants (Magnetostricive and Piezo) 85 - 50 - 0 - 0 Laser based applications†

MASKENOMICS

•

120

Like patients, every procedure is unique. Use your clinical judgment to determine the appropriate level of barrier protection based on the length of the procedure, the amount of fluid aerosol, and standard precautions. LEVEL 2

Based on

TIME + FLUID

FILTRATION SCALE

MASKENOMICS

Procedure recommendations*

160

FILTRATION SCALE

Flame Spread

LIGHT FLUID PROTECTION

FILTRATION SCALE

Differential Pressure Breathability mm H2O/cm2

MODERATE FLUID PROTECTION

MASKENOMICS

Particulate Filtration Efficiency (PFE) @ 1 µm

ASTM LEVEL 1

LEVEL1

Bacterial Filtration Efficiency (BFE) @ 3 µm

ASTM LEVEL 2

HIGH FLUID PROTECTION

MASKENOMICS

LEVEL 2

N95 Fluid Resistance mm Hg

FILTRATION SCALE

LEVEL 3

MASKENOMICS

N95

ASTM F2100-11 standards

FILTRATION SCALE

MASKENOMICS

ASTM LEVEL 3

99.8% 80 mm Hg

ASTM LEVEL 1 •

• • • • •

Ideal for procedures where light amounts of fluid, spray and/or aerosols are produced. Patient exams Operatory cleaning/maintenance Impressions Lab trimming, finishing & polishing Orthodontics

60 - 90 - 0 - 0

* Molinari, John A., Ph.D, and Peri Nelson, B.S. “Face Masks: What to Wear and When.” The Dental Advisor #18 (October 2014) ** Sensitive skin options available in the UltraTM and IsofluidTM Mask lines. † Masks are considered a secondary control and are not meant to replace recommended primary engineering controls for laser plume exposure.

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/maintenance • Impressions • Lab trimming, finishing & polishing

Ideal for procedures where light-tomoderate amounts of fluid, spray and/or aerosols are produced. • Limited oral surgery • Endodontics • Prophylaxis • Restoratives/ composites

• Orthodontics

• 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*

* Masks are considered a secondary control and are not meant to replace recommended primary engineering controls for laser plume exposure. Source: ASTM International (formerly known as American Society for Testing and Materials). ASTM International 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 performance is based on testing for fluid resistance, bacterial filtration efficiency (BFE), particulate filtration efficiency (PFE), breathability (∆ P) and flammability.

Stay ahead of the game

Contaminants can bypass a mask in several ways; a wellfitting mask that can conform to any face shape or size can greatly reduce the risk of infection.

Not only must different face masks be worn for different procedures, they must be a good fit for the wearer. Contaminants can bypass a mask in several ways; a well-fitting mask that can conform to any face shape or size can greatly reduce the risk of infection. Masks with malleable nose and chin closures allow for a customized fit, increasing the effectiveness of mask

protection. Furthermore, guidelines state a mask must be changed with each patient. It’s also recommended that clinicians change their mask every 20 minutes in a moderate-tohigh aerosol environment and every hour in a non-aerosol environment. It’s important to note that the filter media of a mask becomes less effective when wet. And, the best time to determine whether anyone at the practice has skin sensitivities is before new masks are purchased. Colors and inks made from chemicals and dyes are common irritants to the skin. If the inside of the mask is colored or has a print, this may be the cause of irritation. And while a white mask interior is ideal, not all white mask interiors are the same. A white cellulose interior is recommended for sensitive skin. Ideally, masks free of latex, fiberglass, chemicals, inks and dyes should be worn to minimize potential skin sensitivities.

References

1. Chugh, A. “Occupational Hazards in Prosthetic Dentistry.” Dentistry 07, no. 02 (2017). 2. Veena, et al. “Dissemination of Aerosol and Splatter during Ultrasonic Scaling: A Pilot Study.” Journal of Infection and Public Health 8, no. 3 (2015): 260-65. 3. Harrel, S. “Contaminated Dental Aerosols: Risks and Implications for Dental Hygienists”. Dimensions of Dental Hygiene. October 2003;1(6):16, 18, 20. 4. Johns Hopkins Medicine; Health Library. Vital Signs, accessed December 29, 2014. http://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_ diseases/vital_signs_body_temperature_pulse_rate_respiration_rate_blood_pressure_85,P00866/ 5. Ulmer B C. “The hazards of surgical smoke.” AORN J. April 2008; 87(4):721-734.

ISSUE 3 • 2019 : DentalGroupPractice.com 35

Personal Protection Equipment

Gloves

Gloves today are thinner – and offer greater durability – than their predecessors. When selecting the best glove solutions for a dental practice, a lot depends on personal preference. Factors such as flexibility, tactile sensitivity, cost and the potential for allergic reactions to certain glove materials all come into play. “There is no one glove that fits all,” says Alen Kwong, Business Development, Cranberry®. “However, all gloves should provide the comfort and protection that allows dental professionals to work safely in their environment.” The good news is that many gloves today – whether latex, nitrile or another material – are thinner, facilitating greater tactile sensitivity, yet more durable than in years past.

Know your options There are pros and cons to every glove type, notes Kwong. •L atex. Latex gloves have long been considered a trusted glove material for dental markets. Made from natural rubber latex, these gloves are known for their flexibility and fitment properties, as well as their ability to offer reliable barrier protection. That said, some practitioners and patients have allergic reactions to latex gloves, widely deterring their use. • Vinyl. A more economical option than latex, vinyl gloves are made with polyvinyl chloride and are free of latex allergens. Glove wearers, however, often feel vinyl gloves do not offer the same flexibility as latex gloves. • Nitrile. Made with synthetic rubber, nitrile gloves offer nearly the same flexibility and durability that latex gloves provide. Not long ago, some doctors considered nitrile gloves too expensive to purchase. However, newer generations of nitrile gloves have come down in price, and today they are thinner than latex gloves, while retaining their durability. That said, there have been growing concerns over allergic reactions to the chemical accelerators used in nitrile glove manufacturing. As a result, new accelerator-free nitrile gloves are becoming more popular. 36

Efficiency In Group Practice : ISSUE 3 • 2019

•P olychloroprene. Due to the growing concerns over allergic reactions to the chemical accelerators used in nitrile glove manufacturing, accelerator-free nitrile gloves – or polychloroprene gloves – have become more and more popular. Not only are polychloroprene gloves not associated with allergies, their synthetic rubber content is said to closely match the flexibility and barrier protection offered by latex gloves. “Some dental professionals may find it confusing that different gloves are packaged in different quantities, ranging from 100 to 300 gloves per box,” says Kwong. “Their sales reps should be able to calculate a standard unit of cost across the board. While it’s important to make economical choices, however, it never pays to save money at the expense of staff and patient safety.”

Transcend Nitrile PowderFree Exam Gloves with Low Derma Technology Low Derma Technology is a patented formulation with no added allergy-induced chemical accelerators such as dithicarbamate, thiuram and mercatobenziothiazole. Utilizing Low Derma Technology, Cranberry launched Transcend Nitrile Powder-Free Exam Gloves to eliminate the risk exposure of Type I & Type IV allergic reactions. Not only does this ensure a cleaner nitrile for clinicians, Transcend Nitrile Powder-Free Exam Gloves are also built with strong film formation for unconventional strength. Source: Cranberry®

Trends

Periodontal Disease

Understanding the risks of periodontal disease can motivate patients to adhere to a good oral homecare routine. Periodontal disease begins with gingivitis – a mild form that causes the gums to become red, swollen and prone to bleeding. The good news is that, with professional treatment and good oral homecare, the disease is reversible. Left untreated, however, gingivitis can advance to periodontitis. Plaque can spread and grow below the gum line over time, and toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response, causing the tissues and bone that support the teeth to break down. In turn, the gums separate from the teeth, forming pockets, which can become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Eventually, teeth can become loose and may need to be removed. The most common forms of periodontitis include: • Aggressive periodontitis. Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction, and familial aggregation. • Chronic periodontitis. Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur. • Periodontitis as a manifestation of systemic diseases. This often begins at a young age. Systemic 38

Efficiency In Group Practice : ISSUE 3 • 2019

conditions, such as heart disease, respiratory disease and diabetes, are associated with this form of periodontitis. • Necrotizing periodontal disease. Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such, as HIV infection, malnutrition and immunosuppression. Dental professionals should remind their patients that while brushing, flossing and using mouthwash can help prevent periodontal disease, a number of factors in addition to plaque can affect their gums: • Age. Studies indicate that older people have the highest rates of periodontal disease. Data from the Centers for Disease Control and Prevention indicates that over 70 percent of Americans 65 and older have periodontitis. • Smoking and/or tobacco use. In addition to being at risk of illnesses such as cancer, lung disease and heart disease, tobacco users also are at increased risk for periodontal disease. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. • Genetics. Research has indicated that some people may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting

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them into early intervention treatment may help them keep their teeth for a lifetime. • Stress. Stress is linked to many serious conditions, including hypertension and cancer. It’s also a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases. • Medications. Some drugs, such as oral contraceptives, anti-depressants and certain heart medicines, can affect oral health. Dental professionals should ask their patients what medications they take and inquire about any changes in their overall health. • Clenching or grinding teeth. Clenching or grinding teeth can put excess force on the supporting tissues of the teeth, speeding up the rate at which these periodontal tissues are destroyed. • Other systemic diseases. Other systemic diseases that interfere with the body's inflammatory system may worsen the condition of the gums. These include cardiovascular disease, diabetes, and rheumatoid arthritis.

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•P oor nutrition and/or obesity. A diet low in important nutrients can compromise the body's immune system and make it harder for the body to fight off infection. Because periodontal disease begins as an infection, poor nutrition can worsen the condition of the gums. In addition, research has shown that obesity may increase the risk of periodontal disease. Although symptoms of periodontal disease often don’t appear until an advanced stage of the disease, dental professionals can educate their patients to recognize warning signs, including: • Red, swollen or tender gums or other pain in the mouth. • Bleeding while brushing, flossing, or eating hard food. • Gums that are receding or pulling away from the teeth. • Loose or separating teeth. • Pus between the gums and teeth. • Sores in the mouth. • Persistent bad breath. • A change in the way the patient’s teeth fit together when he/she bites. • A change in the fit of partial dentures. ISSUE 3 • 2019 : DentalGroupPractice.com 39

Trends

Comprehensive evaluation and treatment In 2011, the American Academy of Periodontology published the Comprehensive Periodontal Therapy Statement, which recommends that all adults receive an annual comprehensive evaluation of their periodontal health. In its statement, the AAP noted that “as a result of advances in knowledge and therapy, the majority of patients can retain their dentition over their lifetime with proper treatment, reasonable plaque/biofilm control, and continuing care.” A comprehensive assessment of a patient’s current health status, history of disease and risk characteristics should include the following: •E xtra- and intraoral examination to detect non-periodontal oral diseases or conditions. • Examination of teeth and dental implants to evaluate the topography of the gingiva and related

structures; to measure probing depths, the width of keratinized tissue, gingival recession, and attachment level; to evaluate the health of the subgingival area with measures such as bleeding on probing and suppuration; to assess clinical furcation status; and to detect endodontic-periodontal lesions. • Assessment of the presence, degree and/or distribution of plaque/biofilm, calculus and gingival inflammation. • Dental examination, including caries assessment, proximal contact relationships, the status of dental restorations and prosthetic appliances, and other tooth- or implant-related problems. • An occlusal examination that includes determining the degree of mobility of teeth and dental implants, occlusal patterns and discrepancy, and determination of fremitus.

The oral-systemic health connection Periodontal disease may begin in the mouth, but patients don’t always realize that its effect on their health can reach much further. Research has shown that periodontal disease is associated with several other diseases: •D iabetes. People with diabetes are more susceptible to contracting infections, including periodontal disease. In fact, periodontal disease is often considered a complication of diabetes. Those who don't have their diabetes under control are especially at risk. Furthermore, periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar and putting people with diabetes at increased risk for diabetic complications. • Heart disease. While a cause-and-effect relationship has yet to be proven, several studies have

shown that periodontal disease increases the risk of heart disease. Scientists believe that inflammation caused by periodontal disease may be responsible for the association. Periodontal disease can also exacerbate existing heart conditions. • Stroke. Studies have pointed to a relationship between periodontal disease and stroke. • Osteoporosis. Researchers have suggested a link between osteoporosis and bone loss in the jaw, placing people at risk for tooth loss. • Respiratory disease. Research has found that bacteria that grow in the oral cavity can be aspirated into the lungs, causing respiratory diseases such as pneumonia, especially in people with periodontal disease. • Cancer. Researchers found that men with gum disease were 49 percent more likely to develop kidney cancer, 54 percent more likely to develop pancreatic cancer, and 30 percent more likely to develop blood cancers.

Source: The American Academy of Periodontology. For more information visit https://www.perio.org/ consumer/types-gum-disease.html.

Efficiency In Group Practice : ISSUE 3 • 2019

• Interpretation of current and comprehensive diagnostic-quality radiographs to visualize each tooth and/or implant in its entirety and assess the quality/ quantity of bone and establish bone loss patterns. • Evaluation of potential periodontal-systemic interrelationships. • Assessment of the need for and suitability of dental implants. • Determination and assessment of patient risk factors, such as age, diabetes, smoking, cardiovascular disease and other systemic conditions associated with development and/or progression of periodontal disease. Clinical findings, together with a diagnosis and prognosis, should be used to develop a treatment plan, including non-surgical, surgical, regenerative and cosmetic periodontal therapy or dental implant placement, to arrest or deter further disease progression, according to the AAP. When indicated, the plan should include:

• Medical and dental consultation or referral for treatment, when appropriate. • Surgical and non-surgical periodontal and implant procedures to be performed. • Consideration of adjunctive restorative, prosthetic, orthodontic and/or endodontic consultation or treatment. • Provision for ongoing re-evaluation during periodontal or dental implant therapy and throughout the maintenance phase of treatment. • Consideration of diagnostic testing, which may include microbiologic, genetic or biochemical assessment or monitoring during the course of periodontal therapy. • Consideration of risk factors, including, diabetes and smoking, which play a role in the development, progression and management of periodontal diseases. • Periodontal maintenance program, including ongoing evaluation and reevaluation for treatment.

Source: The American Academy of Periodontology. For more information visit https://www.perio.org/consumer/ types-gum-disease.html. ISSUE 3 • 2019 : DentalGroupPractice.com 41