EGP-MJ 19

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

MAY/JUNE . 2019

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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

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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.

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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.

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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.

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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.

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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?

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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.”

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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.

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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

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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.”

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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

Boost case acceptance in every operatory

“ 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

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?

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

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?

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.

Sponsored: Midmark

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

30

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.

Experience the Midmark Difference Deliver a better care experience with mechanical room equipment you can count on for high performance and efficiency.

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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

Efficiency In Group Practice : ISSUE 3 • 2019

• 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.

®

™

Engineered to protect what’s behind the mask

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

(888) 276-7783

info@crosstex.com

crosstex.com

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)

80

120

160

Bacterial Filtration Efficiency (BFE percent) @ 3.0 µm

≥ 95%

≥ 98%

≥ 98%

Particulate Filtration Efficiency (PFE percent) @ 0.1 µm

≥ 95%

≥ 98%

≥ 98%

(ΔP breathability) (mm H2O/cm2)

< 4.0

< 5.0

< 5.0

Flammability (flame spread)

Class 1

Class 1

Class 1

Differential Pressure

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

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Efficiency In Group Practice : ISSUE 3 • 2019

®

Mask Feature Guide B

A K E

F

H

C

J

I

L

G D OUTSIDE

INSIDE

Outside

Inside

A

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

G

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

B

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

H

C

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.

D

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

K

E

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.

L

F

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

A

UltraTM Sensitive Mask (White 50/Box GCFCXSSF)

C

D

F

G

H

•

•

•

•

•

•

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 TM

B

•

•

E

I

J

K

•

•

• •

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

L

®

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

Class 1

®

80

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.

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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.

40

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

Sponsored: Nordent

Looking Sharp A key to productivity, effective treatment and patient comfort in the hygiene department

The hygiene appointment is the most frequent interaction that dental practices have with their patients. All dental practices, particularly group practices, depend on the hygiene department to provide patients with a good experience and comfortable, effective treatment that will keep them coming back. In order to provide high quality treatment, hygienists must have the tools they need, which includes sharp instruments. Most practices recognize that it is important and cost effective to purchase scalers and curettes from a quality manufacturer, because they will stay sharp, perform better and last longer than off brand and low-end instruments.

All scalers and curettes, of any manufacture and any material, get dull with use and need to be sharpened. Scalers and curettes that are coated with titanium nitride (thin, gold-colored material) cannot be sharpened and must be discarded and replaced when they become dull. Some scalers and curettes are made from more advanced formulations of stainless steel, such as Hu-Friedy EverEdge® and Nordent XDURA®, and stay sharp longer than traditional stainless steels. However, these products will still dull with use and need to be sharpened. Therefore, keeping the instruments sharp becomes one of the greatest challenges for hygienists in every practice.

A time savings All hygienists know the value of working with sharp scalers and curettes. Sharp instruments provide the patient with a much more comfortable appointment, greatly reduce strain and fatigue for the hygienist, make procedures more efficient and add to productivity. Most importantly, hygienists require sharp instruments to remove calculus cleanly and reduce burnished calculus, particularly subgingivally.

Maintaining a regular sharpening schedule is challenging for many offices.

Many clinicians are not comfortable with their sharpening technique and put off sharpening because they are concerned they will sharpen the instruments incorrectly. Sometimes multiple hygienists use and maintain the same instruments, each with a different sharpening technique. Sometimes there is disagreement within the office about how often each instrument should be sharpened.

For most offices, the biggest challenge is TIME. As hygienists are required to provide a broader spectrum of treatment options and offices have become more 42

Efficiency In Group Practice : ISSUE 3 • 2019

focused on productivity, the demands on hygienists’ time have increased and maintaining regularly scheduled instrument sharpening has become challenging. When asked, many hygienists will say that they sharpen when they can or when they have a cancellation. However, many dentists and office managers require hygienists to make patient recalls or manage other activities during cancellations.

Often, the result is that hygienists begrudgingly get used to working with dull instruments, and patient care and productivity suffers.

Nordent has developed a solution that fits today’s real world of dentistry. All Nordent XDURA and Relyant® scalers and curettes come with free, unlimited, professional sharpening for life. That means that at any time, an office can send their XDURA or Relyant scalers to Nordent and they will be professionally sharpened, free of charge. Nordent also offers professional sharpening for all brands of instruments, in order to provide offices with a complete, hands-off solution.

In addition, when XDURA or Relyant scalers become too thin to use, they can be traded in for a new instrument at a 40 percent discount; these trade-in instruments also come with free sharpening. Over the past five years, Nordent has developed a system and materials to make the process fast and easy. They even provide a 24-hour in-house turnaround.

Many offices have found that with the XDURA or Relyant system, they can ensure they are always using sharp instruments, they save time and frustration in the office, and they are able to devote more time to focusing on patient care.

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Infection Control

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.

44

Compliance and Infection Control in the Dental Lab The dental lab: Itâ&#x20AC;&#x2122;s something the dental team never wants to discuss! Upon entering the lab, they inevitably see model trimmers heaped with dental stone, lathes with scruffy rag wheels, bins of various materials, vacuum-forming machines and metal blocks holding countless stones, discs, burs and lots of dust. And, while infection control and safety team members tend to overlook the dental lab, it can pose unique challenges for the practice, which need to be addressed.

Clean and safe According to the Centers for Disease Control and Prevention (CDC), dental prostheses, appliances and items used in their fabrication (e.g., impressions, occlusal rims and bite registrations) are potential sources for cross-contamination and should be handled in a manner that prevents exposure of DHCP, patients or the office environment to infectious agents.1,2 So, how can dental labs be kept clean and safe for dental healthcare personnel and patient care? In short, to ensure the lab is clean, only items that have been cleaned and disinfected should enter the lab.

Efficiency In Group Practice : ISSUE 3 â&#x20AC;˘ 2019

The CDC points out that dental prostheses, impressions, orthodontic appliances and other prosthodontic materials should be thoroughly cleaned (i.e., blood and bioburden removed), disinfected with an EPA-registered hospital disinfectant with a tuberculocidal claim, and thoroughly rinsed before being handled in the in-office laboratory or sent to an off-site laboratory. And, the best time to clean and disinfect these items is as soon as possible after removal from the patient's mouth, before drying of blood or other bioburden can occur.1 Team members should consult with the manufacturer regarding the type of disinfectant that is appropriate for use on each item, as some cleaning products may modify or alter impressions and other dental materials.

Although most dental settings have an in-office lab, many continue to rely on external labs as well; specific protocols must be in place for both to ensure safety and decreased risk of occupational exposure to microorganisms. For starters, lab should have an area designated for receiving and disinfection. Barriers should be placed on countertops, and the area should be cleaned and disinfected on a regular basis, depending on how busy the lab is.1,2 Additionally, the American Dental Association and the CDC recommend that all saliva-contaminated items be rinsed with water and disinfected before being sent to a lab, and items returning from a lab must be disinfected before being delivered to the patient.3 Lab cases and items sent to and from an external lab must include explicit written procedures for transport and receiving, as well as for returning cases that have been cleaned and disinfected for patient use.

During patient care, prostheses often must be handled and/or taken to the lab for adjustments. In these cases, itâ&#x20AC;&#x2122;s advisable for dental professionals to immediately rinse each item with water after taking it from the patient. With appropriate personal protective equipment (PPE) in place, items can be placed in a beaker or zip-lock baggie containing an ultrasonic detergent; the entire unit should then be placed in an ultrasonic machine for cleaning and disinfection. If there is heavy debris on an item, it may require some initial scrubbing prior to ultrasonic

cleaning. After disinfection and any necessary lab work, the item must be thoroughly rinsed and returned to the patient in a mouth-rinse solution, free from chemicals.2 Impressions must be thoroughly rinsed with water; then, depending on the impression material and what disinfectant is compatible with that material, the impression can be immersed or sprayed with disinfectant. According to researcher C.H. Miller, itâ&#x20AC;&#x2122;s preferable to immerse items with an EPA-registered disinfectant, as spraying disinfectants releases chemicals into the air and does not ensure constant contact of the disinfectant with all surfaces of the impression.2,3

Disinfecting lab equipment A lot of blasting, polishing and grinding takes place in dental labs. Again, to keep equipment as clean as possible and avoid cross-contaminating patients, only clean items

A lot of blasting, polishing and grinding takes place in dental labs. Again, to keep equipment as clean as possible and avoid crosscontaminating patients, only clean items must be brought into the lab. must be brought into the lab. For instance, the lathe can be a dangerous machine, as it has whirling wheels, stones and bands, which generate aerosols, spatter and projectiles.2 Along with ensuring that machine guards (e.g., a plexiglass shield) are in place and utilized, the same OSHA standards for use with PPE, cleaning, disinfecting and barrier protection apply to the dental healthcare personnel working in the lab. To ensure the lathe is not the culprit of cross-contamination, a unit-dosed system should be used. Fresh polishing compounds in unit doses, sterilized or disposable rag wheels and disposable pan liners all should be available.2,3 Miller recommends that the lathe unit be disinfected twice a day.2 Also, team members should never have food or drink on hand or apply cosmetics in the lab, and refrigerators should only store medical and dental materials.3,4 ISSUE 3 â&#x20AC;˘ 2019 : DentalGroupPractice.com 45

Infection Control

Occupational exposure and PPE Team members must remember that anything coming from a patient’s mouth and entering the lab is contaminated with saliva, bacteria and possibly blood. The CDC states that the transfer of oral microorganisms into and onto impressions has been documented, and the movement of these organisms onto dental casts has also been demonstrated.1 Incorrect handling of contaminated impressions, prostheses or appliances, therefore, can lead

Standards Institute (ANSI). Otherwise, it does not meet OSHA’s requirements.7 Gloves must be worn when working in the lab any time a team member is exposed to blood or other potentially infectious materials, and if chemicals are involved, team members must have chemical resistant utility-type gloves.4,6 Lab coats must be worn to protect workers’ skin and undergarment clothing from splashes, infectious agents and chemicals. And, with all of the dust and exposure to hazardous materials, respiratory protection is vital to lab safety. As such, appropriate masks and respirators are required for this type of exposure.

For instance, crystalline silica has been recently associated with harmful exposures in dental labs. Silica is commonly found in lab products like porcelain, pumice and stone. In response, OSHA introduced the Respirable Silica Standard, which went into effect for all dental labs on June 23, 2018.7,8 OSHA has lowered the Permissible Exposure Level (PEL) for silica by cutting it in half. Under this standard, employers must perform air sampling to determine whether administrative and engineering controls, such as dust collection, are adequate to protect employees.7 While most dental healthcare personnel are focused on patient care and the risk exposure associated with clinical settings, risks and exposure in the dental lab should not be forgotten. All dental settings must ensure that dental healthcare personnel working in the lab are safe for the short – and the long – term. Training dental healthcare personnel on lab safety is critical, and it’s required by OSHA.4,6 Management teams can be role models when they set high standards and foster a culture of safety in the dental setting, including safety in the dental lab.

Dental lab technicians and other dental healthcare personnel working in the lab are considered at risk for occupational exposure and, as such, must comply with OSHA standards for safety and protection. to the transmission of microorganisms, so PPE should be worn until disinfection is completed.1 Dental lab technicians and other dental healthcare personnel working in the lab are considered at risk for occupational exposure and, as such, must comply with OSHA standards for safety and protection.

PPE must include protective eyewear or face protection with impact resistance to guard against splashes, flying projectiles and chemicals. Staff pouring chemicals without the use of proper goggles are violating OSHA standards if the safety data sheet (SDS) specifically requires the use of eye protection.4,5,6 Also, eyewear needs to be rated by an agency, such as the American National References

1. Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings – 2003. MMWR 2003;52 (No. RR-17): 33-34.

2. Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team. 5th ed. St. Louis: Mosby Elsevier; 2013;185.

3. Organization for Safety Asepsis and Prevention. OSHA and CDC Guidelines Interact Training System. Atlanta: OSAP; 2017.

4. US Department of Labor. Occupational Safety and Health Administration. Bloodborne Pathogens Standard; 1910:1030. Available at https://www.osha.gov/pls/ oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS. Accessed March 19, 2019.

5. Daw K, Scungio D. Modern Dental Network. The most common OSHA violations in the dental lab. October 23, 2018. Available at http://www.dentalproductsreport.com/lab/article/most-common-osha-violations-dental-lab. Accessed March 17, 2019.

6. US Department of Labor. Hazard Communication. Available at: ttps://www.osha.gov/dsg/hazcom/. Accessed March 19, 2019.

7. Mott, K. Modern Dental Network. 5 surefire ways to get an OSHA inspection in your dental lab. Available at http://www.dentalproductsreport.com/lab/article/5-surefire-ways-get-osha-inspection-your-dental-lab?page=0,1. Accessed March 17, 2019.

8. US Department of Labor. Silica, Crystalline. Available at https://www.osha.gov/dsg/topics/silicacrystalline/. Accessed March 19, 2019.

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Efficiency In Group Practice : ISSUE 3 • 2019

Specialty Focus

Endodontics

Better technology means more accurate diagnosis and treatment.

Advancements in technology have made it easier for dental professionals to deliver successful endodontic treatment. Nevertheless, endodontics continues to be a specialty that’s best handled by trained experts. “It is appropriate for a general dentist to perform endodontic treatment on a patient when he or she is properly trained to perform the said procedure, has the appropriate equipment and the treatment is within the skill set of that individual clinician,” says Gary Glassman, DDS, FRCD(C). If there’s any doubt the clinician can perform the procedure to the same standard of practice as an endodontic specialist, however, the case should be referred out, he points out. The American Association of 48

Efficiency In Group Practice : ISSUE 3 • 2019

Endodontists (www.aae.org) offers its Case Difficulty Assessment Form and Guidelines to help dentists with case selection, he adds.

Indeed, endodontic cases may present a number of challenges, notes Glassman, including: • The diagnosis of endodontic versus non-endodontic issues.

• Anaesthetizing endodontically treated teeth, especially those that exhibit irreversible pulpitis with or without apical periodontitis.

• Preparing the access cavity while avoiding procedural accidents, such as perforations, gouging or the removal of unnecessary tooth structure.

• The location of root canal orifices, particularly the MB2 canal of the maxillary molar, lingual canals of mandibular incisors and premolars. With the appropriate equipment, clinicians can better locate canals and treat teeth appropriately.

• Negotiating blockages and ledges, and avoiding apical transportation and separated instruments within the canal confines.

• Obturation challenges, specifically well-condensed homogeneous fills, underfills, overfills and impingement on normal anatomic structures, such as the maxillary sinus and mandibular canal.

• Restorative challenges to prevent coronal leakage into a root-canal-treated tooth.

post and cores, he continues. They aid in the debridement of the root canal system during irrigation protocols in a controlled and predictably safe manner.

Cone beam computerized tomography (CBCT) offers practitioners unprecedented accuracy and acuity.

“Clinicians can visualize the tooth in three dimensions, providing them with a road map to the anatomy of the root canal system,” Glassman explains. “In addition, the resolution of the CBCT is higher than traditional radiography, allowing the detection of periradicular pathology, which may have otherwise gone undetected. The type, location and extent of internal/external resorption can now be definitively diagnosed and the relationship of normal anatomic structures can be assessed with ease.”

By staying current on the latest “ Rapid advancements in endodontic technology have technology and techniques, endopermitted us to enjoy higher success rates. Patients dontists can better address these challenges, Glassman says. “Rapid can retain their teeth for as long as possible, reducing advancements in endodontic techthe need for retreatment and/or extraction and nology have permitted us to enjoy thereby limiting the high costs they once faced.” higher success rates. Patients can retain their teeth for as long as pos– Gary Glassman, DDS, FRCD(C) sible, reducing the need for retreatment and/or extraction and thereby An opportunity limiting the high costs they once faced.”

Dental service organizations offer specialists like endoThe dental operating microscope is a prime examdontists an opportunity to connect with general dentists ple, he notes. “The dental operating microscope enables and their patients, who may require advanced care. An clinicians to visualize the anatomy of the pulp chamber. open dialogue between endodontists and their general As a result, they can locate the canal anatomy more profidentist colleagues will help ensure that patients receive the ciently and offer minimally invasive treatment by keeping best possible treatment, Glassman points out. Plus, the access openings as small as practical while maintaining accessibility of the patients within their general dentist’s the structural integrity of the tooth. In addition, practioffice is often more practical and convenient, both for the tioners are able to maintain a more ergonomically favorpatients and the practitioners, he adds. able position, thereby reducing any stress on their back Communication and continuing education are a key and neck.” component of the endodontic-general dentist relationUltrasonic instruments with specially designed endship, he continues, noting that a true partnership between odontic tips allow clinicians to uncover calcified canals, practitioners ultimately leads to better patient care. remove pulp stones, refine access preparations and remove Editor’s note: Dr. Gary Glassman, an inspirational mentor, educator and philanthropist, is a leading endodontic expert with a successful downtown Toronto, Canada, practice. Working hard to help smiles internationally, Gary continually travels around the world, with extensive work in Jamaica, teaching the latest techniques and technologies in dentistry and oral health to developing countries. As a specialist in his field, Dr. Glassman provides his professional opinion and has produced easy-to-follow videos that will engage, while allowing you to learn about how oral health affects overall health and the preventative measures that can be taken to prevent unwanted problems. With a globally recognized reputation for having extensive knowledge in his field, Dr. Glassman is known as an oral health expert throughout the health industry.

ISSUE 3 • 2019 : DentalGroupPractice.com 49

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Efficiency In Group Practice : ISSUE 3 • 2019

Years of relying on traditional cotton roll isolation convinced Dr. Brian Buehler, Laguna Beach Dental Group (Laguna Beach, CA), that there had to be a better – less risky – solution. Today, with the Zyris Isolite® Dental Isolation System, his dental practice can depend on optimal results for every patient.

“The Isolite Dental Isolation System provides a clear, extremely well-lit work environment, providing me and my dental team with high-quality results in a fraction of the time had we used another solution,” he points out. “The Isolite system brings predictability to bonded dentistry. We always have a dry, clean

“The Isolite system brings predictability to bonded dentistry."

field that is well-lit for as long as we assuring consistently great results at need. We needn’t worry about lip and a fraction of the time using traditongue interference, and soaking nasty tional isolation methods. In fact, since cotton-rolls are a thing of the past. Nor adopting the Isolite system, we’ve must we readjust the lighting or strugnearly eliminated the risk of bond failgle to control tissues and fluids. ures and post-op sensitivities.”

With a staff of 10 general dentists, “Most dentists at one time or 13 specialists, eight hygienists practicing another have experienced a mirror slipacross four offices, efficiency and effecping or accidently nicking a patient’s – Dr. Brian Buehler tiveness are key. The hands-free Isolite tongue or cheek,” says Buehler. “And system permits his staff to focus entirely on the patient and who hasn’t had to deal with the suction piece sucking the procedure, Buehler notes. “Safely lassoing a tongue calls the floor of the patient’s mouth into the handpiece! It’s for a lot of attention. A properly placed Isolite system elimitrue, dentists can learn from experiences like these. But, a nates these obstacles, enabling us to focus on the procedure. stressed clinician inevitably will work less ergonomically “Isolite is so effective, I often start a procedure on my and less efficiently. The Isolite system allows dentists to own while my assistant completes another task,” he confocus on the procedure at hand and enables us to provide tinues. “With Isolite, visualization is greatly improved, our patients with the best care possible.”

Productivity, predictability, safety The Zyris Isolite Dental Isolation System provides optimal dental isolation for a number of clinical applications, including restorative, cosmetic, pediatric, periodontal, extraction, implant, laser surgery, sedation, digital imaging and SRP. The system’s continuous, hands-free suction evacuates water, saliva and debris, promising unsurpassed moisture control. With Isolite, patients are no longer at risk for moisture contamination or choking on debris, and clinicians needn’t struggle with tongue and cheek interference. A clear, well-lit line of vision and hands-free operation ensures consistently high-quality results and satisfied patients.

ISSUE 3 • 2019 : DentalGroupPractice.com 51

Enhanced Practice

Changing the Narrative

By Heidi Arndt Heidi Arndt, RDH, BSDH has worked in the dental field for 18+ years. Her experience ranges from working as a treatment coordinator, dental assistant, and practice manager before graduating from the University of Minnesota with a bachelorâ&#x20AC;&#x2122;s degree in Dental Hygiene. In 2011, Heidi founded Enhanced Hygiene.

She is also the founder of Enhanced Practices.

52

Getting non-insured patients engaged in your group practice Research shows that dental benefits are an important driver for dental care use. Patients who have insurance benefits are twice as likely to visit a dentist compared to a person without benefits.1 How many patients do you have visiting your group practice that do not have insurance? How are you addressing these patients?

When you start to look at your patient base, how do you view your non-insured patients? Oftentimes team members will write these patients off as they donâ&#x20AC;&#x2122;t believe they will be compliant or interested in comprehensive patient care. While research does support this assumption, I believe it is our role to change the narrative with these patients.

Ninety-Seven million patients in the United States do not have dental insurance.

According to the ADA, only 40 percent of these patients visit a dentist every year. Why is this? Are we talking to these patients differently? Can these patients afford regular dental care? Do these patients value good oral health?

Efficiency In Group Practice : ISSUE 3 â&#x20AC;˘ 2019

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Enhanced Practice

Here are three ways you can get these patients engaged in your group practice.

1. Educate all patients the same regardless of their insurance or benefits. This may sound elementary, but all too often we’re having conversations and creating treatment plans based on the patient’s insurance coverage. While we want to be conscious of their benefits, we also need to understand the message we are giving our patients.

When training our providers, we need to be sure we are focusing on comprehensive and preventive dentistry.

2. Cost is the number one reason people stay away from the dentist.2 While our providers need to focus on presenting treatment, we need to be ensured the administrative staff understands all of the options for offering affordable dental care to patients, and that they are comfortable doing so.

No matter how the patient is paying, I believe it is best to always take the approach when discussing fees with the patient.

1. S how the UCR fee for the procedure.

2. Subtract out the discounted fee (negotiated PPO fee or Membership Plan fee) 3. E quals the amount due to the patient.

By using this process, you can demonstrate the savings they receive

from their dental insurance or their membership plan. If we are only showing the patient the discounted fee, they cannot see what true savings they are receiving from their plan.

Transparency in fees is important. This transparency will support the patient appreciating the value of the care they are receiving, and the benefits provided by their insurance or membership plan.

Transparency in fees is important.

This transparency will support the patient appreciating the value of the care they are receiving, and the benefits provided by their insurance or membership plan.

3. M embership plans are the future. Ninety-seven million patients don’t have dental insurance, and this creates a perfect opportunity for the dental practice to build a strong relationship with the patient by offering a membership.

Unlike insurance, membership plans encourage plan utilization rather than placing restrictions on plan usage.

• No Maximums • No Deductibles • No Waiting Periods • No Limitations • No Restrictions • No Claims Most membership plans offer a discounted fee for dental care, and other perks that will keep the patient engaged in your practice.

There are many different membership plans available today, and most can be tailored to your dental group. While there are many options available for membership support, it’s important to pick a partner who will support you with the marketing, customer service and the education you need to be successful.

1 Manski R J, Brown E. Dental use, expenses, private dental coverage, and changes, 1996 and 2004. Agency for Healthcare Research and Quality. 2007. MEPS Chartbook No.17. Available from: http://www.meps.ahrq.gov/mepsweb/data_files/publications/cb17/cb17.pdf. Accessed September 27, 2016.

2 Bloom B, Simile CM, Adams PF, Cohen RA. Oral health status and access to oral health care for U.S. adults aged 18- 64; National Health Interview Survey, 2008.

National Center for Health Statistics. Vital Health Stat 10(253). 2012.

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Leadership

Why Nice People Start Turf Wars

By Lisa Earle McLeod

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Steve knew he was facing a challenge. As he walked into the budget meeting, he squared his shoulders and took a deep breath.

The facts were on his side. Now it was time to convince the rest of the senior team, and, most importantly, his CEO. The challenge at hand was the marketing budget. For the last two budget cycles, Steve had been shorted. Or at least that’s how he perceived it. His budget had been cut to the bone while the IT and Operations budgets grew.

This time he was ready. Armed with data about market share and competitive spending, he wasn’t going to let his department go underfunded again. His team was counting on him.

If the leader wants to get everyone going in the same direction, the senior team’s primary alliance must be to each other, and their collective goals.

Steve was relatively new to the senior leadership team. He’d only had a few years as a manager before he’d gotten promoted. But one thing he learned early on was, good leaders fight for their people. For Steve it was all about his team.

The problem was, Steve was fighting for the wrong team.

If you ask most leaders who their team is, they’ll tell you it’s their direct reports. Yet in more successful organizations, a leader’s first alliance is to the larger team. In Steve’s case, that was his peers and the CEO.

Danger of silos Patrick Lencioni, author of the classic book “The Five Dysfunctions of a Team,” says, when team members put

their individual needs or even the needs of their divisions above the collective goals of the team it creates inattention to results. A leadership team with 10 agendas is never as effective as a leadership team focused on one agenda.

Steve is like many well-intended leaders. He cares deeply about his people, and he also cares about the organization’s success. Increasing the marketing budget may be the right thing to do. But Steve’s approach, even if he wins, will only accelerate siloed thinking amongst the team.

In my experience, turf wars are silos with emotion. The original cause is almost never malice. The eventual war is the all too natural result of the three common conditions: No. 1: The expertise trap The VP of marketing is unlikely to know much about IT. Steve is playing in the space he knows, the area he was assigned.

No. 2: Personal connections Most leaders spend more time with their direct reports than their peers. In Steve’s case, he’s relatively new to the role. When you’re in a new job one of the first things you do is connect with your team. Steve has probably been so busy leading his own team he hasn’t built strong relationships with his peers, who he likely only sees at big group meetings.

No. 3: Lack of holistic leadership Because the first two conditions (above) are almost always a given, leaders have to be relentlessly proactive in aligning their teams against the larger organizational goals. If Steve’s boss goes around the table at meetings discussing individual goals and budgets, that’s what people are going to focus on. If the leader wants to get everyone going in the same direction, the senior team’s primary alliance must be to each other, and their collective goals.

Putting department agendas aside in favor of team goals requires trust. Leaders must have confidence their peers are in it for the team, not simply jockeying for themselves. The biggest challenge is, no one wants to go first.

But when teams are brave enough to trust each other, and let go of their divisions, there’s nothing they can not do.

ISSUE 3 • 2019 : DentalGroupPractice.com 57

INDUSTRY NEWS Deer Valley Dental Village sells for $5.6M Menlo Group Commercial Real Estate announced it successfully negotiated the purchase of Deer Valley Dental Village (Peoria, AZ). The dental office complex, located at 7505 W. Deer Valley Rd. in Peoria, Arizona, was purchased for $5.6 million. Andersen Capital Partners (Phoenix, AZ), an investment firm, purchased the 17,030 sq. ft. Class A medical office building, which is fully leased with five long-term dental tenants.

The buyer is a long-time investor in Arizona real estate with a portfolio that includes properties in retail, office and land.

DentaQuest to acquire dental insurer in $41.5M deal DentaQuest (Boston, MA) signed a definitive merger agreement to acquire DCP Holding Co., the parent company of Dental Care Plus Group (Sharonville, OH), a dental insurer provider in the Midwest. DentaQuest will pay $41.5 million for DCPG common shares, minus transaction expenses.

DCPG will also pay cash dividends to shareholders, which is currently estimated to total $8 million. With the acquisition, DentaQuest will cover 380,000 members and a network of 246,000 provider locations. DCPG will keep its headquarters in Sharonville. The transaction is expected to be finalized in the third quarter of this year

Benevis names new CEO Benevis LLC (Marietta, GA) named Rich Beckman as CEO. Beckman has previously been CEO for Great Expressions Dental Centers. Beckman is also a founding member of the Association of Dental Support Organizations (ADSO). Littlejohn & Co. (Greenwich, CT) and Tailwind Capital (New York, NY) led a recapitalization of Benevis in March 2018.

“Benevis is an industry-leading DSO platform, and I am excited to serve as its CEO,” said Beckman. “I was attracted to Benevis’ scaled presence across 17 states, network of high-quality practices, best-in-class compliance program, and dedicated 2,300 employees. I am eager to get started and capitalize on the numerous growth opportunities ahead.”

Geoff Raker, a Partner at Tailwind Capital said, “We are thrilled to have an executive of Rich’s caliber join the Company. He is a proven and passionate leader, and we look 58

Efficiency In Group Practice : ISSUE 3 • 2019

forward to the immediate impact he will have as Benevis continues to expand its existing capabilities and breadth of services, including orthodontics and oral surgery.”

dentalcorp announces promotion of Guy Amini to president dentalcorp has promoted Guy Amini to president of the organization, effective immediately. Since September 2014, Guy has been chief legal and compliance officer. In his new role, Guy will support the company's founder and CEO, Graham Rosenberg, in overseeing day-to-day operations.

He will also focus on building relationships with dental professionals and key industry stakeholders and continue to be responsible for the company's Legal and Compliance, Corporate Communications, and People teams.

G Square Healthcare acquires Dental Care Group G Square Healthcare Private Equity LLP (London, UK), a private equity firm with an investment strategy exclusively dedicated to healthcare companies in Europe, announced the acquisition of Dental Care Group (DCG), a clinician-led business comprised of 21 dental practices in East and South East of England. G Square’s investment in DCG is the first investment by G Square Capital III, the third Fund managed by G Square. G Square has acquired a majority stake in partnership with the Founders who retain a significant shareholding and will continue to manage the company. Financial terms of the acquisition were not disclosed.

Premier introduces AeroPro™ Premier announced the introduction of AeroPro, a light-weight, ergonomic cordless and pedalless handpiece that gives dental care providers the mobility they want, the choice of prophy angles they like, and the control they need. Its innovative design helps reduce hand fatigue.

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Additional Safe & Effective Solutions

• Mild and effective.

• Multi-surface disinfectant.

• Helps maintain skin health and formulated for frequent use.

• Soft and durable hand wipes.

• Waterless surgical scrub.

• Free of parabens, triclosan, and phthalates.

Push-Style

• Hand sanitizer stands for patient waiting rooms.

Touch-Free

®

®

ES4

ES8

PURELL®

1200 mL

1200 mL

Surface Disinfectant

5030-01 5034-01

7734-01 7730-01

PURELL® Healthcare Surface Disinfectant Broad-spectrum, one-step surface disinfectant and cleaner.

5085-02

7785-02

32 oz.

Pour Gallon

3340-06

4340-04

80 Ct.

175 Ct.

9030-12

9031-06

PURELL®

5072-02

7772-02

Hand Sanitizing Wipes PURELL Hand Sanitizing Wipes Alcohol Formula Soft, durable, non-linting wipes. ®

Push-Style

Touch-Free

CS4

CS8

1250 mL

1200 mL

5130-01

7830-01

Refills

Touch-Free

Touch-Free Waterless Surgical Scrub

CS8

Dispenser

1200 mL 7810-01

PURELL® Touch-Free Waterless Surgical Scrub Dispenser Touch-free dispenser for healthcare environments.

Surgical Scrub Refills 5181-03

7881-02

PURELL® Healthcare Waterless Surgical Scrub Designed to meet and exceed FDA surgical scrub requirements.

PURELL®

535 mL

Hand Sanitizer Stands

5775-04

Elegant floor stand reinforces high-quality standards.

Available in White or Graphite.

Foam Pump Bottle

7869-02

7318-DS-SLV 7308-DS-SLV

7720-DS 7724-DS

PURELL® P

Choosing the Right Dispenser for Your Practice Push-Style

Touch-Free

ES4 in White

ES8 in Graphite

White

Graphite

White

A complete solutio improve patient an

Graphite

• Multiple mounting options for ultimate adaptability.

• Easy-to-install refills snap in quickly for easy maintenance.

• No charge dispensers, talk to your distributor rep to learn about the program.

Consider a Floor Stand for Your Waiting Room & High-Traffic Areas • The dispenser stand boasts a sleek design to seamlessly fit into your office, waiting room, or lobby.

Customizable Spaces

• From logos on dispensers, custom header signs, or a complete personalization of the PURELL MESSENGER™ Floor Stand, you can showcase your commitment to cleanliness, health, and well-being.

Header signs can be personalized with various sizes and styles.

Please use the provided ma Us

Hand Sanitize

One recommen

Sanitizer Dis Sanitizer Bo Sanitizer Sta

Hand Soap

One recommen

Soap Dispen Soap Bottles Customize your dispenser with your logo.

Surface Disinf

One recommen

Surface Disi Notes:

See your logo on a dispenser: http://gojo.com/en/Dispenser-Customization

©2019 GOJO Industries, Inc. All rights

Free

PURELL® Perfect Placement™ Suggestions A complete solution with trusted products in the right locations to help improve patient and staff satisfaction.

Make PU

phite

aphite

y.

ance.

t the program.

oasts a sleek design ur office, waiting

ers, custom header sonalization of the loor Stand, you can ment to cleanliness,

a dispenser: nser-Customization

Please use the provided map and list to help determine where and how to incorporate Purell® products into your practice.

Use tally marks to identify number of products needed for your practice.

Hand Sanitizer

One recommended per room.

Quantity:

Sanitizer Dispensers: Operatories Sanitizer Bottles: Desks & Countertops Sanitizer Stands: Waiting Rooms & Elevators

Hand Soap

One recommended per sink.

Quantity:

Soap Dispensers: Operatories & Restrooms Soap Bottles: Break Room & Smaller Sink Areas

Surface Disinfectant

One recommended per room.

Surface Disinfectant Bottle: Operatories, Break Room, & Work Stations Notes: GOJO Industries, Inc. One GOJO Plaza, Suite 500 P.O. Box 991 • Akron, OH 44309-0991 Tel: 1-330-255-6000 • Toll-free: 1-800-321-9647 • Fax: 1-800-FAX-GOJO ©2019 GOJO Industries, Inc. All rights reserved.

Quantity:

Pe Patien