EGP Nov/Dec 19

Moving Forward

As doctors grow in their profession, so must dental assistants. DSOs provide the opportunities they need.

. 17 G P E SE CESS C A O T SIVE U L C EX ENT T N O C NOVEMBER/DECEMBER . 2019

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Editor’s Note

A Good Impression

ADSO Summit 2020..................................................... 4

Braced for Best Outcomes

Dentists of Brighton, Pacific Dental Services

Amid growing options for orthodontic treatment, orthodontists continue to offer patients their unique expertise...........................28

Millennial owner and Generation X associate bring customization to patient-centric practice...................................... 6

Blue Light: An ocular risk

Moving Forward

Safety protocols must keep pace with advances in dental materials and techniques................................................32

As doctors grow in their profession, so must dental assistants.

DSOs provide the opportunities they need..................................14

OSAP Dental Infection Control Boot Camp™..... 36

Dental assistants? More like dental leaders..................................... 2

Organic Organizational Effectiveness

The Dental Assistant With advances in technology, dental assistants must be prepared to play an instrumental role in the practice......................18

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

Conventional impression materials continue to prove their value......26

Three leadership imperatives from The Biggest Little Farm.............42

News............................................................................. 48

EDITOR Laura Thill • lthill@sharemovingmedia.com MANAGING EDITOR Daniel Beaird • dbeaird@sharemovingmedia.com SENIOR EDITOR Graham Garrison • ggarrison@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 6 • 2019 : DentalGroupPractice.com

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/ Editor’s Note /

Dental assistants?

More like dental leaders.

Laura Thill

Dental technology has seen its share of change during the past two decades, and dental professionals have worked hard to stay current. Dental assistants are no exception. Long gone are the days of maskless, gloveless staff members standing by to take orders. Today’s assistants diligently adhere to the latest OSHA guidelines, and often oversee the rest of the dental team to ensure it does the same. They have become tech savvy, relying on computers for scheduling and patient charts. And, they have pursued continuing education credits to advance their knowledge and credentials as they assume more office responsibility.

Dental assistants today continue to support their dentist. But the term assistant falls short of describing the full extent of the support they offer, not only to the dentist but to the entire team.

“Ten years ago, there weren’t digital scanners,” says Nina Diasio, a dental assistant coach and OSHA/HIPAA compliance officer at Chicago-based Acierno Family Dentistry, a DecisionOne Dental Partners supported practice. “Doctors weren’t doing as much Invisalign or placing implants. Today, it’s vital for dental assistants to be able to take a great digital impression.

As the doctors grow in their profession, we have to move right along with them.” Dental assistants who are not willing to learn new techniques and adapt to new technology won’t go far in their profession, she adds.

That said, there are numerous growth opportunities for today’s dental assistants. In addition to working as a dental assistant for 18 years, Diasio has assumed the role of dental assistant coach and OSHA representative for DecisionOne Dental Partners. As such, she helps train and onboard all new assistants, as well as ensure the DSO’s practices are OSHA compliant.

Tim Whitaker, DMD, Marquee Dental Partners, agrees that dental assistants today require a much broader base of knowledge than in the past. “Dental assistants today work with much more technically advanced equipment, which assistants could not even imagine 10 years ago,” he says. In addition, they need a clear understanding of drugs used for local anesthesia and sedation, computer skills and sterilization protocols, he adds. “As a result, they must be more highly educated and involved than ever before.”

Dental assistants today continue to support their dentist. But the term assistant falls short of describing the full extent of the support they offer, not only to the dentist but to the entire team.

One might ask: Considering how much the dental assistant’s role has evolved, is it time for a title change as well?

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Efficiency In Group Practice : ISSUE 6 • 2019

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/ ADSO News / Association of Dental Support Organizations

ADSO Summit 2020

The Association for Dental Support Organizations (ADSO) is the primary champion and representative of the group practice and dental support business model in the country. Our members span the breadth of the sector.

We are proud to represent the interests of emerging DSOs that we support through education, training and mentorship to help them grow their business, as well as national DSOs that we support through our advocacy efforts. We are committed to meeting the varied needs of our members, no matter what stage of scale and development they are, so that they can focus their efforts on promoting the highest quality patient care.

Due to ADSO’s unrivaled access to sector leaders, we have been able to regularly host the premier DSO-focused conference since 2014, our annual Summit meeting. By calling on our members – both DSOs and Industry Partners – to share their insights and experiences, we’ve created an unrivaled educational experience for the sector, which has been growing every year since its inception. This is an incredibly exciting time to be a DSO or group practice leader, and through the cooperation and support of our community we are able to share our learnings to

Our members span the breadth of the sector. support the growth and development of this business model.

Join us in March 2020 at National Harbor to hear from some of the most successful names in the industry as they share what they have learned on their

path to success. Membership with ADSO is not required for DSO and group practice attendees, though our members do receive complimentary registrations. Organizations that provide products and services to DSOs and group practices who are interested in attending, sponsoring or exhibiting at Summit 2020 must join the ADSO Industry Partner program first and can request additional information from membership@theADSO.org.

We hope to see you there! If you would like to know more about ADSO’s annual Summit, contact ADSO at info@theADSO.org or by phone at 703-940-3860.

Together we can create practice environments where dentists can choose the administrative services that best allow them to focus on patients, expand access to quality dental care and improve the oral health of their communities.

www.theadso.org/event/national-harbor-2020-adso-summit 4

Efficiency In Group Practice : ISSUE 6 • 2019

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/ Group Practice Profile /

Dentists of Brighton, Pacific Dental Services Millennial owner and Generation X associate bring customization to patient-centric practice.

Dentists of Brighton is a Pacific Dental Services® supported practice located in Brighton, Colo. Practice owner Ian McLean, DDS, heads a team of 16, including his associate, Brad Guyton, DDS, and a team of 10 affiliated specialty members. Dr. McLean is a millennial and Dr. Guyton brings the Generation X perspective. Together, though, they share a common goal – to provide all patients with the highest level of care possible and a patient-centric experience. The support from a leading dental service organization (DSO) makes this possible.

“We have standardized systems, integrated specialties and a maniacal focus on the patient experience – all of which impact patient outcomes,” says McLean. “Ours is a methodical, intentional, patient-centric practice.

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Our clinicians have the flexibility to customize every aspect of their interaction with patients, which is complemented with clearly defined standards and coaching to help them understand what patients want.

“With integrated specialties, we can create a practice that provides the highest level of care for each patient,” he continues. “Patient compliance is improved when the general dentist, patient and specialist can all discuss treatment together in the same room. For example, we no longer worry about patients being referred to an endodontist and then falling into a black hole. We share a common electronic health record (EHR) and see our specialists frequently to receive feedback and follow-up on patient care. The faceto-face interaction we get with our

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/ Group Practice Profile /

specialists makes us better dentists.”

“At the office level, we have more time to dedicate to patients because of the back end support we receive from our regional and national DSO teams,” says Guyton. “The support we receive around insurance and billing allows us to estimate a patient’s out-of-pocket cost with a high degree of confidence.

New patients often tell us they left their last dentist’s office because they received an unexpected bill, and we can confidently tell them that this will never happen at our practice.

Dr. Ian McLean

We don’t have to chew up valuable time on this. Instead, we can spend that time forming valuable connections with our patients and ensure they receive the individualized care they deserve.”

Efficiency in Group Practice: How does your practice implement new technology efficiently and effectively?

Dr. Ian McLean and Dr. Brad Guyton: When it comes to our clinical teams, the training our DSO provides is unparalleled in the group practice industry. When we were 8

Efficiency In Group Practice : ISSUE 6 • 2019

both in private practice, the costs to the practice were often prohibitive for ongoing training and education.

After purchasing new and expensive equipment, there often was no budget for training in these new technologies and techniques. This is never the case in our supported environment. When we implement new technology, like CEREC, lasers and guided implant placement, we have help overcoming the two biggest obstacles: cost and training. We have exceptional partnerships with world-class vendor partners who

Dr. Brad Guyton

provide equipment and supplies at extremely competitive rates, as well as training to supplement our in-house curricula.

Efficiency in Group Practice: As more millennials enter the dental industry, how has this impacted your practice?

Dr. Ian McLean and Dr. Brad Guyton: As a millennial practice owner and a Generation X associate that loves millennials, we are encouraged by the millennial workforce and look forward to learning more about the Generation Z that is now

entering dental school. Millennials are looking to provide great patient care and have a patient-centric practice, just like prior generations. The cost of joining our profession is now significantly higher than it used to be. Student loan payments are exorbitant, and the quality continuing education (CE) necessary to provide excellent care can also be costly.

Dr. Ian McLean: As a new graduate dentist in 2016, I was not able to afford to pay for any CE at all. I felt like I was stagnating as a clinician.

Many of my colleagues expressed to me that they felt this way for several years before they were able to enroll in substantial CE courses. After joining a PDS-supported practice, I had the opportunity to receive high-quality training from experts in their respective fields. This was provided at no cost to me, so I was able to enroll in these courses immediately. My clinical ability has improved rapidly, and my patients benefit from this. Millennials are digital natives; they are looking for a practice with high-tech solutions to improve the patient experience, and they are willing to flex their hours to be more patient-centric than traditional private practices. Surprisingly, with all the great millennials in our practice, we still stay on budget, even with the expensive line item of avocado toast!

Efficiency in Group Practice: What do your patients especially value about your dental practice?

Dr. Ian McLean and Dr. Brad Guyton: In the past, to retain great patients we had to give patients one good reason to stay. Now the line

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/ Group Practice Profile /

between the patient and consumer has become blurred, and patients expect more convenience. We expand hours and keep schedules flexible so that we can see patients today. Often the busiest time of our day is 4-7 p.m., which doesn’t allow us to have dinner at home every evening but builds loyalty with patients extremely quickly. Patients

approach to patient care. How has this impacted the way your dental professionals work with patients?

Dr. Ian McLean and Dr. Brad Guyton: We have taken a proactive approach to the mouth-body connection through multiple channels, such as patient education, salivary testing, OSA sleep referral, and linkage conversations around

“ At the office level, we have more time to dedicate to patients because of the back end support we receive from our regional and national DSO teams.”

– Brad Guyton, DDS

love the modern feel of our well-architected office; they appreciate the technology we have and the highest standard of care.

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

chronic disease and oral health. We have a perio protocol that ensures each patient receives a full-mouth probe and accurate diagnosis from the dentist at least once per year.

We subscribe to, and document, the new American Academy of Periodontology (AAP) guidelines.

The tools provided by Pacific Dental Services in terms of AAP

guidelines and partnership with salivary testing vendors has made these types of best practices simple to implement. The DSO platform also provides ongoing education to reinforce these practices.

Efficiency in Group Practice: In your experience, what does the growing DSO market mean for traditional solo practices?

Dr. Ian McLean and Dr. Brad Guyton: Solo and group practices will always be able to co-exist in the marketplace. We live in an exciting time, when dentists have numerous great models to choose from based on their preferences. Dentists who prefer to make all the business decisions can be wildly successful in solo practice. Dentists who prefer onsite collaboration and proven systems may find this in a small or group practice environment. Some dentists want to be business people, some want to be exceptional clinicians, and some have the capacity to be both.

The future of dentistry is extremely promising with expanded access to resources, vendor partnership, greater focus on patient centricity at an affordable cost, more integrated technology solutions and innovative practice models. It isn’t the model of practice that makes a great dentist. It’s the dentist.

Biographies Ian McLean, DDS, is a 2016 graduate of the University of Colorado School of Dental Medicine and the owner of Dentists of Brighton, a practice supported by Pacific Dental Services® in Brighton, Colo.

Brad Guyton, DDS, MBA, MPH, serves as the vice president of clinician development for Pacific Dental Services. He is an associate professor at the University of Colorado School of Dental Medicine and practices dentistry at the PDS-supported practice Dentists of Brighton. Dr. Guyton is a graduate of Baylor College of Dentistry and has fellowships from Harvard University in geriatric dentistry and from the American College of Dentists (ACD).

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Efficiency In Group Practice : ISSUE 6 • 2019

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/ Sponsored / Crosstex

Efficient Protection VistaCool™ Direct-to-Drain Cooling System for Autoclave Wastewater saves staff time while protecting cabinetry and drains from steam-sterilizer exhaust.

Adhering to proper sterilization protocols in the dental practice is key to infection control and the safety of patients and staff. But sterilization comes with its share of challenges. For instance, with steam sterilization, autoclaves that use fresh water for each cycle must exhaust wastewater in the form of steam and condensation. Most sterilizers discharge this steaming-hot exhaust into some form of condenser bottle, which is typically located beneath the sterilizer inside a base cabinet. It’s important that this sterilizer wastewater is managed properly, but dealing with it can be problematic.

Over the course of multiple sterilization cycles, these condenser bottles fill up and can get very hot. It’s not unusual for busy practices to have to empty the bottles many times throughout the week, creating additional tasks for office staff members.

If the bottles are emptied too soon, before they have sufficiently cooled, the wastewater can actually melt plastic plumbing. On the other hand, if the bottles aren’t emptied frequently enough, they can overflow inside the cabinet. In addition, spills and steam that escape from condenser bottles create a humid environment, which can contribute to delamination, mildew, rot and rust inside sterilization center cabinets.

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Efficiency In Group Practice : ISSUE 6 • 2019

user maintenance required. Unlike other systems, only the VistaCool™ Direct-to-Drain Cooling System for Autoclave Wastewater can refresh its own coolant water when it senses that the water in the tank has become too warm to serve as an effective coolant.

Not only does the system prevent sterilizer wastewater from melting plumbing, the CSA-certified backflow prevention meets or exceeds most local plumbing codes. And because cooled wastewater is sent directly down the drain, dental professionals can rest assured their cabinets will be protected from potential damage due to spills or the humid environments created by exhaust from condenser bottles.

Consider this!

Few dental professionals would question the importance of sterilization.

But the sterilization process inevitably raises several questions, such as: • How will the steam sterilizer exhaust be collected and managed?

• Will our staff have to monitor and manually empty the sterilizer wastewater multiple times

each week? If so, how much time will this take, and how safe is it for them to handle bottles of hot condensation?

• What are the odds of a condenser bottle overflowing if the staff becomes busy and forgets to empty it?

• Could our dental cabinets become warped, delaminated or otherwise damaged as a result of steam from condenser bottles?

The VistaCool™ Direct-to-Drain Cooling System for Autoclave Wastewater is approved for use with some of the leading fresh-water sterilizers on the market, including both newer and older SciCan STATIM 2000 and 5000 units, as well as the Midmark and Ritter M3. For practices that prefer using fresh water instead of recirculated water for sterilization, the double-sterilizer model of the VistaCool™ Direct-to-Drain Cooling System for Autoclave Wastewater enables Midmark and Ritter M9 and M11 UltraClave Automatic Sterilizers to use fresh water for each cycle by sending wastewater directly to the drain. This modification requires the use of a simple, Midmark-approved adapter kit.

Learn more at Crosstex.com/VistaCool.

Editor’s note: Sponsored by Crosstex International Inc, a Cantel Medical Company.

/ Dental Assistants /

Moving Forward As doctors grow in their profession, so must dental assistants.

DSOs provide the opportunities they need.

Working in a dental service organization (DSO) comes with its share of opportunities, according to Nina Diasio, a dental assistant coach and OSHA/HIPAA compliance officer at Chicago-based Acierno Family Dentistry, a DecisionOne Dental Partners supported practice. At the same time, given how quickly DSOs adopt new technology, dental assistants today must be fast learners, she adds.

Dental assistants today continue to be indispensable to the dentist, whether they work in a private practice or a DSO, notes Diasio. “However, there are many more opportunities in a DSO situation,” she says.

For instance, it’s much easier to find a replacement in a DSO setting when scheduling vacation or sick time, she points out. “If I want to schedule a vacation, I can always find someone 14

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from another DecisionOne Dental Partners office to fill in for me.” As a result, the practice rarely needs to rely on a temp service, she explains, and it’s an opportunity for those looking to add extra hours.

Dental assistants working in DSOs also benefit from growth opportunities they may not have in a private practice, she continues. “I have been a dental assistant for 18 years,” she

By Laura Thill

says. “For the last three years, in addition to chairside assisting, I have taken on the role of dental assistant coach and I’m the OSHA representative for our DSO. As such, I help train and onboard all new assistants, as well as ensure our practices are OSHA compliant.” And, she’s confident she’ll continue to grow professionally in years to come.

New technology, new responsibilities DSOs are well-positioned to adopt new technology, which means better patient care. Dental professionals today can catch and treat more oral health issues than ever before, Diasio points out. “As a result, our patients

are healthier and can keep their teeth longer,” she says. “The challenge for the dental team, however, is that we must stay on our A-game at all times, whether that means keeping up with technology or being able to properly educate patients. Technology has become a much greater part of our job and we need to move quickly to keep up with it.”

Indeed, dental assistants today have a whole new and sophisticated set of responsibilities. “Not only are we now seeing more patients and doing a lot more dentistry, but the new materials and technology are very technique sensitive,” says Diasio. “We are expected to learn and do a lot more than we did 10 years ago. For instance, our offices have started to use laser therapy for periodontal treatment. The lasers are very technique sensitive and the care for the lasers is very particular.

Even though dental assistants don’t use the laser equipment, we need to learn everything about the procedure and the equipment in order to educate the patients and properly care for the equipment.

“Ten years ago, there weren’t digital scanners,” she continues. “Doctors weren’t doing as much Invisalign or placing implants. Today, it’s vital for dental assistants to be able to take a great digital impression. As the doctors grow in their profession, we have to move right along with them.” Dental assistants who are not willing to learn new techniques and adapt to new technology won’t go far in their profession, she adds.

The same but different While protocols are in place at DecisionOne Dental Partners to ensure

A higher standard As OSHA guidelines become stricter, dental assistants are held to higher infection prevention standards, according to Nina Diasio, a dental assistant coach and OSHA/HIPAA compliance officer at Chicago-based Acierno Family Dentistry, a DecisionOne Dental Partners supported practice. Dental assistants today must incorporate more infection prevention and control protocols into their daily routine, she points out. “Complying with OSHA is a huge priority for all of our offices at DecisionOne Dental Partners,” she says. “We hire a third party to come in and make sure we are up to date on OSHA and HIPAA standards, as well as provide us with the necessary training to help us keep up with these new protocols.

Bloodborne pathogens can exist in any dental office, she continues.

“We must ensure we protect the office team and our patients, each moment. OSHA is here to protect us. Its standards and protocols are constantly changing and we have to make sure we stay current.”

“ As the doctors grow in their profession, we have to move right along with them.”

– Nina Diasio, a dental assistant coach and OSHA/HIPAA compliance officer at Chicagobased Acierno Family Dentistry, a DecisionOne Dental Partners supported practice.

a degree of consistency, each office is unique, according to Diasio. “We insist that every office follows the same standard of patient care and comply with OSHA standards,” she explains. “It’s important that patients can have a great experience at any of our offices. However, the doctors at DecisionOne Dental Partners are given a good amount of autonomy about how they run their office. As such, the dental assistants in our group only need to be in sync with their office. My job as the dental assistant coach is to visit all of the offices in the DSO and make sure the assistants are comfortable and enjoy their job and answer any questions

they may have about the systems or protocols in place at their office.”

Diasio anticipates the patient experience will become increasingly more important in years to come, further impacting the role of dental assistants. “Patients are always looking for a better experience, whether it is at the front desk or in regard to their health,” she says, and the dental team will continue looking for ways to deliver the best possible service. For dental assistants, this will mean continuing to evolve with the profession and staying current with the latest techniques and technology. “Dental assistants will be more important in years to come than ever before,” she says.

ISSUE 6 • 2019 : DentalGroupPractice.com 15

/ Dental Assistants /

Assisting the Assistant

When hygienists and dental assistants can work more efficiently, dentists and patients benefit.

16

Unlike dentists, dental assistants and hygienists don’t have an assistant sitting chairside, ready to help. And many of their responsibilities – for instance, moisture control and patient safety – can be challenging. Thanks to advances in technology, however, today’s dental teams can work more efficiently than ever before.

upper and lower quadrant during a procedure and greatly improving the patient experience.

Saliva no longer pools in the back of patients’ mouth and blood can be evacuated without their tasting it.

Hygienists and dental assistants benefit as well. With continuous suction, hygienists avoid continuous interruptions to use the saliva ejector to maintain a dry field and keep patients comfortable. And because the Isovac (together with the mouthpiece) isolates two quadrants at once, they can work more quickly. Finally, hygienists have a consistent amount of room to work throughout the procedure, enabling them to work more efficiently.

Dental assistants work hard to anticipate what the dentist needs as far in advance as possible. But it can be difficult to act quickly when they are tied up providing suction and retraction. The Isolite mouthpiece retracts patients’ tongue and cheek, freeing dental assistants to do their job more efficiently.

Efficient moisture control Proper control of saliva, water and blood in the mouth contributes largely to patient comfort.

When hygienists and dental assistants are tied up providing suction and retraction, however, they cannot assist the dentist with other important tasks, leading to increased chair time for the patient.

For many dental practices, the solution has been to add the Isovac dental isolation adapter

by Zyris. The Isovac connects to an existing HVE line, providing continuous suction for both the

Safety first Patient safety in the operatory is an absolute, and while the dental staff does all it can to avoid accidents, the risk exists for a patient to swallow a temporary crown or a clinician to drop an implant screw. The Isolite mouthpiece by Zyris provides a barrier that obturates the throat, while retracting the tongue to help minimize the risk of a foreign object being aspirated or ingested. And knowing their patients are safe is peace of mind – and one less distraction – for the entire dental team.

Efficiency In Group Practice : ISSUE 6 • 2019

Quality, Productivity, Efficiency, Safety and Predictability Our patented dental isolation system has been shown to increase safety, efficiency, productivity, collections per hour, production, standards of procedures, while reducing staff overhead. Let us help you streamline your practice to enhance your clinical care, maximize your scheduling and help improve the patient experience.

The patented Isolite Mouthpiece has been specifically designed and engineered around the anatomy and morphology of the mouth to accommodate every patient.

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Learn how our isolation systems can help support your group practice https://zyr.is/egp-demo

/ Sponsored / Zyris

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For nearly 20 years, Zyris has been helping clinicians to achieve a high standard of care through its highly-effective, technologically-advanced, award-winning solutions for minimally invasive, easy-to-use dental isolation — as well as control of the oral environment.

Zyris’ new Isolite 3 dental isolation system provides unparalleled visibility, better oral humidity control, and minimizes the chance of accidental contamination. The system’s patented design allows dentists to quickly and easily implement a standard protocol for consistent outcomes in procedures that benefit from and require moisture control and isolation.

Zyris’ new eBook, published in partnership with Share Moving Media, drills down into how the Isolite 3 system can improve each aspect of the dental practice.

The first chapter addresses the clinical benefits that will be realized by dentists switching to the Isolite 3.

Namely, the chapter covers how the Isolite 3 will help clinicians to elevate the quality of their work while also being able to complete dental procedures up to 30% faster than using traditional methods of isolation. The chapter also discusses how the system’s Liquidmetal® construction makes the device sturdier and more ergonomic, as well as how the Isolite 3’s brighter illumination and new amber light can provide a superior lighting experience.

The second chapter reveals how the Isolite 3 can help hygienists to achieve superior results for dental procedures that require isolation.

The chapter covers how the Isolite 3 system helps to reduce neck and back pain for users as well as reducing chair time per patient. Better isolation means better, faster, safer and more comfortable procedures – for both clinicians and patients.

Importantly, this chapter deals with the challenges of traditional 4-hand dentistry, and how the Isolite system helps to overcome those challenges so that the hygienist can always stay one step ahead of the dentist.

The final chapter of Zyris’ eBook is a thorough look at the value-prospect of the Isolite 3 system. This chapter, aimed at those who work in the dental practice’s “back office” shines a light on how the features

of the Isolite 3 device can help dentists achieve superior results while reducing chair times and increasing patient comfort. It also takes a look at the various financial benefits to the dental practice – from the company’s 30-day trail to its outstanding warranty program.

Dental practices of all sizes can benefit from the new Isolite 3 system. To access the eBook, www.zyris.com/smm.

ISSUE 6 • 2019 : DentalGroupPractice.com 17

/ Dental Assistants /

The Dental Assistant With advances in technology, dental assistants must be prepared to play an instrumental role in the practice.

18

By Laura Thill

Continual advances in technology, a growing focus on improving the patient experience and achieving best possible outcomes has impacted the role of dental assistants. “Dental assistants today require a much broader base of knowledge than in the past,” says Tim Whitaker, DMD, Marquee Dental Partners. Not only must they understand different materials and how they interact with other substances, they need advanced knowledge and training to stay on top of new technology, he points out.

Mastering new technology

“Regardless of whether they are working in a stand-alone practice or a dental service organization (DSO), dental assistants have three key responsibilities,” says Whitaker.

• First, their job is to provide a clear working field for the

Patient care is a top priority for the entire dental team, dental assistants included. But technologies such as digital X-ray, chairside printing and 3D milling require specialized knowledge and education, according to Whitaker. “Mastering new technologies and techniques requires advanced training, including both

Efficiency In Group Practice : ISSUE 6 • 2019

dentist in a timely manner, with minimum discomfort to patients and resulting in a quality restoration.

• Second, they must educate and relax patients by explaining the treatment that’s to be provided,

as well the value of additional treatments needed.

• Third, dental assistants must be instrumental in providing a safe, clean environment for patients.

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/ Dental Assistants /

classroom and hands-on training,” he says. While this may eat into the time dental professionals can spend chairside, continuing education is a must, not an option, he adds. Once new technology and techniques are mastered, the dental team can work more efficiently, resulting in greater office productivity, decreased chair time, better patient results and less stress for both patients and staff.

well as commonly prescribed medications, over-the-counter drugs and supplements,” he continues. “They also need computer skills for using dental practice management software to enter treatment notes and plans for future treatment.

Greater demands That dental assistants today are asked to work with more sophisticated technology and play a bigger role in the operatory is a testimony to their value to the industry. But greater responsibility

“ Dental assistants today work with much more technically advanced equipment, which assistants could not even imagine 10 years ago. As a result, they must be more highly educated and involved than ever before.”

– Tim Whitaker, DMD, Marquee Dental Partners

means enhanced training to prepare for the position. “Dental assistants today work with much more technically advanced equipment, which assistants could not even imagine 10 years ago,” says Whitaker. “As a result, they must be more highly educated and involved than ever before.

“It’s particularly helpful for dental assistants to have a basic understanding of drugs used in the dental office for local anesthesia and sedation, as 20

Efficiency In Group Practice : ISSUE 6 • 2019

“Dental assistants must have a clear understanding of the processes required for disinfection and sterilization and be able to prepare the room and equipment in accordance with correct sterilization processes, in order to provide a safe and clean environment for the patient,” he explains. In addition, they must be able to read and understand equipment manuals in order to follow complex and ever-changing infection prevention protocols.

In multiple site group practices and DSOs, dental assistants must adhere to consistent standards and protocols, Whitaker points out.

“In order to ensure efficiency, it is important to have standard, consistent protocols within the multiple offices of a DSO,” he says.

“This can be achieved by company-wide training.”

It’s also important for dental assistants in DSOs to maintain consistency when ordering supplies, notes Whitaker. “In solo practices, the dental assistant can simply talk to the dentist and together they can decide on materials, quantities and the best time to place an order,” he says. “In a DSO, there are firm budgets with specific formularies, making coordination and communication among offices especially important.

“A decade ago, we could not have predicted the technology and treatment innovations that have reshaped the role of the dental assistant,” says Whitaker. “Mastering these advances will continue to require additional training and an investment in materials – both in school and through continuing education.

“Regardless of what changes in technology occur in the future, the dental assistant will continue to play an instrumental role in the dental practice, ensuring patients are comfortable, educated and safe,” he says. Moving forward, dental assistants will play a greater and greater role in helping dentists be more productive and effective, he notes. “As such, there will always be a demand for well-trained, proficient dental assistants, and I believe that need will continue to grow in the years ahead.”

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Dental Zirconia and Keys for Clinical Success

By Shashikant Singhal, B.D.S., M.S., director of professional services, Ivoclar Vivadent, Inc.

Dentists have increasingly requested zirconia as an alternative to porcelain-fused-to-metal (PFM) restorations and more recently to glass ceramic restorations as well. For more than 15 years, zirconia has been used for fabricating restoration frameworks based on the material’s versatility in mechanical and physical properties, which has allowed clinicians and laboratory technicians to use it for various clinical indications. The first zirconia restorative materials on the dental market were 3Y-TZP powders. Although these materials had high mechanical properties, they were dense and opaque, falling short of meeting dentists’ requirements for esthetics, which were equally important to strength considerations. Since then, the number and compositions on dental zirconia materials have grown rapidly.

Figure 1

With recent advancements, a variety of zirconia materials (4Y-TZP, 5Y-TZP) has become available to meet dentists’ different functional and esthetic demands. Differentiated by a number of factors – including composition, mechanical and optical properties – today’s new zirconia materials offer dentists and laboratories solutions that can be milled to full contour, and that demonstrate acceptable esthetics and translucency suitable for clinical situations where high mechanical stability, thin restoration walls and natural esthetics are essential.

What is dental zirconia?

Figure 2

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Efficiency In Group Practice : ISSUE 6 • 2019

Dental zirconia (ZrO2) is the oxide version of zirconium (Zr). Zirconium occurs in nature only as a mineral – mostly as zircon (ZrSiO4) – and is a soft, ductile, shiny-silvery metal, optically similar to aluminum foil.1,3 To produce dental zirconia, zircon is purified via complex production and purification processes and converted into synthetic zirconium precursors, which are finally transformed into ZrO2 through thermal and mechanical processes. These are the only synthetic powder components used to make dental zirconia.1-3 Zirconia is polymorphic ceramic; depending on temperature and pressure, the same elements of the material exist in three different crystal structures (i.e., monoclinic (m); tetragonal (t);

Table 1 – Dental Zirconia Classification 3Y-TZP Zirconia

4Y-TZP Zirconia

5Y-TZP Zirconia

4.5 – 6.0 wt percent Y2O3

6.0 – 8.0 wt percent Y2O3

9.05 – 10.0 wt percent Y2O3

~100 percent Tetragonal phase

~75 percent Tetragonal phase

~50 percent Tetragonal phase

0 percent Cubic phase

~25 percent Cubic phase

~50 percent Cubic phase

HIGHEST Mechanical Properties (~1,200 MPa)

HIGH Mechanical Properties (~850 MPa)

LOWEST Mechanical Properties (~650 MPa)

LOWEST Translucency

HIGHER Translucency

HIGHEST Translucency

Tetragonal phase helps with fracture toughness and strength while the Cubic phase helps with translucency

and cubic (c)). Pure monoclinic zirconia, the most stable phase, is present at room temperature. At about 1170°C, the monoclinic phase transforms into the tetragonal phase, with an approximately 4-5 percent volume shrinkage. At about 2370°C, the tetragonal phase then converts into the cubic phase. These transformations occur within a temperature range (rather than at a specific temperature) and involve movement of atoms within the crystal structure.

The tetragonal and cubic phases of zirconia can be made stable at room temperature by incorporating additional components (dopants), such as yttrium oxide (Y2O3), calcium oxide (CaO) or magnesium oxide (MgO) into the ZrO2 crystal structure to form partially or fully stabilized zirconia.1-3 Without the addition of these components, tetragonal converts back into a monoclinic below 950°C and, hence, cannot be used clinically. (Figure 2).

Low amounts of these dopants lead to partially stabilized zirconia, with mainly metastable tetragonal and cubic phases.1-3 For example, how much dopant in molar concentration is used in a zirconia is abbreviated as 3Y-TZP for 3 mol percent Y2O3; 4Y-TZP as 4 mol percent Y2O3; or 5Y-TZP as 5 mol

percent Y2O3. When approximately 4.5-6 wt percent (3 mol percent or 3Y-TZP) yttria is added to a structure, a 100 percent tetragonal phase (traditional dental zirconia) can be produced at room temperature. When approximately 9.0-10.0 wt percent (5 mol percent or 5Y TZP) yttria is added, a structure of 50 percent tetragonal/50 percent cubic phase (known as cubic or HT zirconia) can be produced at room temperature. When these powders are mixed, an approximately 6.5-8.0 wt percent yttria containing zirconia can be produced (4 mol percent or 4Y TZP) giving a microstructure of 75 percent tetragonal and 25% cubic (Table 1).

The composition of zirconia material defines its mechanical and physical properties and hence clinical indications. The biaxial flexural strength of zirconia materials ranges from 650 MPa (5Y-TZP) to 1,200 MPa (3Y-TZPP). The higher the value, the stronger the material. In addition, the presence of polymorphic phases in zirconia material provides a phenomenon known as phase transformation toughening. It causes the tetragonal crystals to change to monoclinic when a crack is introduced. The monoclinic phase has a greater volume. This stops the crack from traveling through the

material, basically pinching the crack shut (Figure 2) and, hence, further increases resistance to fracture. No phase transformation toughening can be observed in 5Y-TZP materials.

Lastly, the translucency of 3Y-TZP is comparatively lower than 4Y-TZP and 5Y-TZP (most translucent), resulting in a clinical decision-making tree for clinical indications and cementation procedures.

Ensuring clinical success with today’s different zirconia materials As discussed earlier, the obvious disadvantage of new higher translucency and more esthetic ZrO2 materials is a reduction in the mechanical properties (e.g., lower fracture toughness, lower strength). There is a growing interest in using zirconia for fabricating monolithic, full-contour restorations – particularly different generations that demonstrate new levels of optical and mechanical properties to meet dentists’ demands. The composition, mechanical properties, optical characteristics and processing of these new zirconias are different from previous generations of the high-strength material.4,5 Currently, newer generation cubic – 5Y-TZP (e.g., CubeX2) or hybrid – 4Y-TZP (e.g., IPS e.max® ISSUE 6 • 2019 : DentalGroupPractice.com 23

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ZirCAD MT) zirconia materials are limited to single-unit restorations, or to three unit bridges. These zirconias exhibit improved translucency for esthetic full-contour (i.e., monolithic) restorations, but they demonstrate lower mechanical properties and a reduction in strength and fracture toughness compared to some other restorative materials.6,7 This may limit their use to certain indications, wall thicknesses and connector dimensions.

The 3Y-TZP zirconia materials (e.g., IPS e.max® ZirCAD LT) are indicated for single-unit restorations to multi-unit bridge frameworks with a maximum of two pontics. These materials demonstrate high-strength, excellent mechanical properties and a low risk of temperature degradation; however, they exhibit a slightly lower level of translucency8. The newest generation of zirconia restorative material (IPS e.max® ZirCAD PRIME) has been introduced with a unique gradient technology. This technology allows gradation of 3Y-TZP and 5Y-TZP material in one puck, ensuring the strength of 3Y-TZP and esthetics of 5Y-TZP. Therefore, clinicians should follow tooth preparation guidelines specific to their selected zirconia restorative material. It is also critical for both clinicians and dental laboratory technicians to consider the differences in properties among zirconia materials when selecting the ideal zirconia for a specific clinical indication.

Figure 3

Figure 4

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Efficiency In Group Practice : ISSUE 6 • 2019

Figure 5

Figure 6

Preparation guidelines for 3Y-TPZ zirconia materials range from 1.0 mm to 0.5 mm occlusal and axial reduction, whereas for 4Y-TZP and 5Y-TZP zirconia restorative materials, they range from 1.5 mm to 1.0 mm reduction (Figure 3). Additionally, the connector dimensions for bridges vary from 12.0 mm2 for 5Y-TZP and 4Y-TZP materials, compared to 7.0 mm to 9.0 mm2 for 3Y-TPZ zirconia materials.

Further, although there are various cementation options available for use with zirconia restorations (e.g., conventional, self-adhesive and adhesive cements), it is important to remember that the actual technique – and diligently following its protocol – also influences clinical restorative success. Clinicians often use conventional cements (e.g., resin modified glass inomers or glass inomers) when placing zirconia restorations, due to their ease of use. However, the limited bonding properties of conventional cements restrict their use in non-retentive tooth preparations.

The common myth is that zirconia material cannot be chemically bonded. However, it is well cited in the literature that zirconia restorations can be adhesively cemented if proper

steps are followed. To ensure successful cementation, the following critical protocol should be implemented with zirconia restorations. Avoiding any step in the cementation protocol will compromise the clinical outcome.

1. Zirconia restorations cannot be chemically etched. Traditional dental etching procedures are preferential and involve etching away the open glass phase structure in glass-ceramic restoration, like IPS e.max® lithium disilicate; this leaves the crystals, since zirconia has no secondary glass phase. Therefore, sandblasting the intaglio surface of a zirconia restoration using Al2O3 particles (50 μm) at 1 bar pressure – which is usually performed by the dental laboratory – roughens the zirconia surface to increase micro-retention for improved bonding.

2. After a try-in of the zirconia restoration in the patient’s mouth, it should be cleaned. Zirconia surfaces show a high affinity for phosphate groups, and saliva and other body fluids contain various forms of phosphate (e.g., phospholipids) that may react

irreversibly with the restorative surface and compromise bonding. This also contraindicates the use of phosphoric acid on zirconia restorations. To clean zirconia restorative surfaces after try-in and create an optimum surface for adhesive bonding compared to other cleaning protocols, a unique product (Ivoclean®, Ivoclar Vivadent, Inc.) is indicated9, 10 (Figure 5).

3. The cementation of zirconia restoration can be performed using an adhesive cement (e.g. Variolink® Esthetic, Multilink® Automix) or a self-adhesive cement (e.g., SpeedCEM® Plus). The cementation protocol includes application of primer on the restoration, followed by the use of cement. Unlike glass-ceramic bonding, which uses silane bonding, zirconia bonding uses phosphate end groups to bond.

The use of primers containing phosphate end groups, or cements containing MDP (10-methacryloyloxydecyl dihydrogen phosphate), is recommended for achieving the best bonds to the tooth structure.

The MDP-containing ceramic primers (e.g. Monobond Plus) should be applied on the restoration followed by extrusion of adhesive resin cement in the restoration. Because few self-adhesive resin cements (e.g., SpeedCEM® Plus) contain MDP, the application of restorative primer as a separate step can be eliminated. Finally, cement is extruded in the restoration; the doctor should seat it per path of insertion, followed by polymerization of the cement per the manufacturer’s recommendation. Lastly, the translucency of the zirconia restorations depends on the material’s composition and thickness, and hence light attenuation through the restoration varies. Therefore, it is critical to consider these factors while selecting the cement options. For opaque restoration, use of self-cure and dual-cure cements are recommended, and it is extremely important to let the cement set on a self-cure mode before checking occlusion or making occlusal adjustments.

References

1. Volpato Maziero CA, D’Altoe Garbelotto LG, Celso Fredel M, Bondioli F. Application of zirconia in dentistry: biological, mechanical and optical considerations. Advances in Ceramics-Electric and Magnetic Ceramics, Bioceramics, Ceramics and Environment. 2011:397-421.

2. Chen YW, Moussi J, Drury JL, Wataha JC. Zirconia in biomedical applications. Expert Rev Med Devices. 2016 Oct;13(10):945-963.

3. Nielsen RH, Wilfing G. Ullmann. Zirconium and zirconium compounds. Ullmann’s Encyclopedia of Industrial Chemistry. 2010.

4. Miyazaki T, Nakamura T, Matsumura H, Ban S, Kobayashi T. Current status of zirconia restoration. J Prosthodont Res. 2013 Oct;57(4):236-61.

5. Ramos CM, Cesar PF, Bonafante EA, et al. Fractographic principles applied to Y-TZP mechanical behavior analysis. J Mech Behav Biomed Mater.

2016 Apr;57:215-23.

6. M unoz EM, Longhini D, Antonio SG, Adabo GL. The effects of mechanical and hydrothermal aging on microstructure and biaxial flexural strength of an anterior and a posterior monolithic zirconia. J Dent. 2017 Aug;63:94-102.

7. Z hang F, Inokoshi M, Batuk M, et al. Strength, toughness and aging stability of highly-translucent Y-TZP ceramics for dental restorations.

Dent Mater. 2016 Dec; 32(12):e327-e337.

8. P into PA, Colas G, Filleter T, DeSouza GM. Surface and mechanical characterization of dental yttria-stabilized tetragonal zirconia polycrystals (3Y-TZP) after different aging processes. Microsc Microanal. 2016 Dec;22(6):1179-88.

9. K im DH, Son JS, Jeong SH, Kim YK, Kim KH, Kwon TY. Efficacy of various cleaning solutions on saliva-contaminated zirconia for improved resin bonding. J Adv Prosthodont. 2015 Apr;7(2):85-92.

10. Pathak K, Singhal S, Antonson SA, Antonson DE. Effect of cleaning protocols of saliva-contaminated zirconia-restorations: shear bond strength.

J Dent Res. 2015;94 (Spec Iss A):3656.

ISSUE 6 • 2019 : DentalGroupPractice.com 25

/ Specialty Focus / Impression Materials

A Good Impression Conventional impression materials continue to prove their value.

There’s no denying dental technology has rapidly digitized in recent years. Still, many traditional technologies, such as conventional impressions, continue to play an important role in patient healthcare. Conventional impressions are still required for subgingival tooth preparations. In addition, impression materials can displace blood and saliva, whereas digital impression systems are not able to capture the margin when moisture or soft tissue blocks the tooth preparation. From gingival retraction pastes to compact intraoral syringes for efficient application of wash material, the technology behind conventional impressions is continually improving.

From general dentists to orthodontists, prosthodontists and oral surgeons, dental professionals continue to rely on conventional impressions to create custom restorations, such as crowns, bridges and implants, as well as orthodontic appliances.

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Efficiency In Group Practice : ISSUE 6 • 2019

A history of precision Since reversible hydrocolloids were developed in the 1930s, enabling dentists to make impressions of undercuts, precision impression materials have become increasingly versatile. Soon after, dentists began

using polysulfides and C-type silicones, although these materials were associated with shrinkage.

By 1965, ESPE – currently 3M Oral Care – had introduced polyether impression material as a single-step, medium viscosity impression material. Considered unique for its time, polyether impression material was known for its highly mechanical properties and excellent elastic recovery. And, there was virtually no concern about shrinkage.

Dentists could depend on the material’s intrinsic hydrophilicity, and unique flow and setting behavior.

Polyether materials have been the go-to material for challenging cases.

Their long working time and excellent flowability has facilitated precision and accuracy in implants and large restorations. Today’s polyether impression materials include viscosities, from heavy-body tray materials to lightbody materials, enabling them to be used for a full range of indications.

Soon after the invention of polyether impression materials, new silicone chemistries were introduced, which were formulated with improved hydrophilicity. Vinyl polysiloxanes (including VPS/PVS, additional silicones and A-silicones) have always been intrinsically hydrophobic, but the addition of a surfactant has improved hydrophilicity. Recent vinyl polysiloxanes are known to contain tailor-made cross linkers designed for high tensile strength, resulting in high tear resistance and

high elastic recovery. These materials are commonly used with popular double-bite and one-step techniques.

By selecting the proper working and setting time of a material, a full range of crown and bridge indications can be accomplished.

Alginates Developed in the late 1930s, soon after reversible hydrocolloids, alginates continue to be used for preliminary impressions. They generally are mixed by hand, since their material properties are only slightly improved with mixing devices. However, alginates provide poor surface detail reproduction and impressions must be cast within 15-30 minutes, since the impression shrinks as water evaporates from the alginate gel. This makes alginate impressions poorly suited for the preparation of temporary restorations, since they cannot be stored and reused. That said, alginates have low tear resistance, which can sometimes be an advantage, as when taking an impression of a periodontally affected tooth or over-fixed orthodontic appliances.

These cannot be reproduced with tear-resistant materials, since that material cannot be removed from the patient’s mouth.

As an alternative, alginate replacements were introduced as cost-effective VPS materials offering high-dimensional stability. Alginate replacements are used to fabricate temporary restorations, as their smooth silicone surface can be easily trimmed. And because the impression has an unlimited shelf life, it can be used to remake

temporary restorations when needed.

These materials can be automatically mixed with hand dispensers or automatic mixing systems, eliminating mixing and processing errors.

Is it time to make a change?

Dentists might ask themselves if their current impression material has merely been doing the job. If so, there may be a solution better suited

From gingival retraction pastes to compact intraoral syringes for efficient application of wash material, the technology behind conventional impressions is continually improving.

Hand-mixed vs. automatic All impression materials must be mixed from at least two components – usually a base and catalyst paste.

Most impressions are still performed with hand-mixed materials, although hand dispensers with dual-barrel cartridges have been available since 1983 and automatic mixing systems for foil bags since 1993.

Ergonomic and clinical considerations often prompt dental practices to upgrade to automatic mixing systems. These systems enable dental professionals to fill the impression tray with the touch of a button, saving time and reducing stress. In some cases, a dental practice will upgrade after experiencing problems with an inadequate mix or to reduce material costs associated with hand dispensers.

to the needs of their practice. Some points to consider include: • What do I like/dislike about my current impression material? Is there something I would like to change?

• What percentage of impression retakes are necessary using my current impression material?

• How long do my impression appointments generally take?

• Would upgrading to an automatic mixing system help increase office efficiency at my practice?

Over time, impression materials have proven their value, and they likely will continue to do so for years to come. Equipped with the right solutions, dentists and their assistants are more likely to achieve the best possible results.

Editor’s note: Efficiency in Group Practice would like to thank 3M for its assistance with this article.

ISSUE 6 • 2019 : DentalGroupPractice.com 27

/ Orthodontics /

Braced for Best Outcomes Amid growing options for orthodontic treatment, orthodontists continue to offer patients their unique expertise.

A beautiful smile can do wonders for our self-esteem, particularly when our photo is plastered across Facebook and Instagram. And patients today have more options for improving their smile than ever before – from ordering aligners online to seeking treatment from a general dentist. That said, some dental professionals believe there are advantages to working with an orthodontist.

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Efficiency In Group Practice : ISSUE 6 • 2019

By Laura Thill

For one, orthodontists bring additional training – usually between two and three years of specialized academic and clinical training – to the operatory, compared to general dentists. “This equips the specialist

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to treat a wide range of orthodontic patients utilizing the appropriate methods,” says Rasheed Khalifa, DDS, an orthodontist based in Manteca, Calif. “Most importantly, the specialist’s knowledge of human growth and development helps the specialist arrive at the correct diagnosis of the orthodontic problems, leading to better treatment results.

“Addressing an improper bite or malocclusion in its various manifestations is the most common reason I treat orthodontic patients,” Khalifa says. “Common examples of improper bite are excessive overjet (often referred to as over-bite or buck teeth) under-bite, anterior deep-bite, anterior open-bite, individual tooth or teeth cross-bite, rotated teeth, spaced or crowded teeth.”

Although he typically recommends fixed metal braces for teenagers and ceramic fixed braces for adults, in some cases, patients can be fitted with clear aligners. But this isn’t the best option for every patient, he adds. “While clear aligners have made orthodontic treatment appealing to teen and adult patients who are not comfortable wearing braces, in some cases, they

may not be the right choice for the correction they require.”

In fact, for some extreme cases, even traditional treatment with fixed braces will not suffice. For instance, to treat jaw abnormalities in growing children, Khalifa modifies their growth pattern

A day’s work

Rasheed Khalifa, DDS

utilizing myofunctional removable appliances. Gross skeletal jaw abnormalities in non-growing patients may require orthognathic surgical correction, such as orthodontics combined with jaw surgery, he says. Thanks to technological advances like digital

“ From the patients’ perspective, they are very aware of the need for orthodontic treatment when their teeth are crooked, obviously spaced or they have a gross over or underbite. And social factors like social media and selfies have made the public even more conscious of their smiles.”

– Rasheed Khalifa, DDS

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Efficiency In Group Practice : ISSUE 6 • 2019

X-ray and scanners and 3D printers, orthodontists can provide more accurate diagnoses and efficient treatment. And the incorporation of nickel/titanium alloy in arch wires and coil springs has nearly eliminated the need for pulling teeth in patients with crowded or underdeveloped jaws, he says.

On a typical day, Khalifa sees between 30 and 40 patients, either to place braces, make necessary adjustments, remove orthodontic appliances or check bite stability on patients already in retention. “The majority of these patients require adjustments, such as activating their orthodontic appliances by bending or changing arch wires and/or changing their elastomers,” he explains.

It’s common for a patient to schedule an emergency visit because an arch wire is poking his or her gums and must be cut flush. But, the day after Halloween traditionally is one of the busiest days of the year for emergency calls, according to Khalifa. Indeed, sticky, chewy or hard treats can play havoc on orthodontic appliances.

“We promote the American Association of Orthodontists’ Orthodontic Health Month recommendations and post braces-friendly tips on social media, but we still end up with calls regarding broken braces and wires,” he says.

Emergencies aside, however, some patients simply are less motivated than others when it comes to complying with treatment, Khalifa says. Teens sometimes require regular encouragement to wear their removable elastics or maintain good

oral hygiene, he says. “We talk to them and sometimes offer reward programs. In fact, we’ve improved compliance by offering patients points toward a monthly movie ticket drawing.”

That said, patients generally do what it takes to get the best possible results. “I emphasize to patients that straight teeth are easier to clean and lead to lifelong better oral and overall health,” says Khalifa. “From the patients’ perspective, they are very aware of the need for orthodontic treatment when their teeth are crooked, obviously spaced or they have a gross over or underbite. And social factors like social media and

selfies have made the public even more conscious of their smiles.”

Greater competition As more general dentists have added orthodontics at their practice, and patients have more options for treatment, orthodontists must work harder to market their services, according to Khalifa. “In order to remain competitive, orthodontists must market their practice heavily,” he says. “This can be accomplished the traditional way, by establishing good rapport with the referring general dentists. But I also recommend in-house marketing by the whole staff, which should reflect the

desired image of the practice. This may include programs that keep patients and their families engaged with the office and the treatment, as well as community involvement.

“In this era of the patient experience, it’s especially important that orthodontic practices take full advantage of online and social media to reach their market niche, as well as offer contests and rewards to engage young patients and their families,” says Khalifa. Bottom line, he explains, orthodontists want to see patients benefit from an improved smile, facial appearance and oral health, and inevitably, better self-esteem.

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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.

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Blue Light: An ocular risk Safety protocols must keep pace with advances in dental materials and techniques In the hustle and bustle of today’s busy dental practices, safety must remain a priority. Compliance to Occupational Safety and Health Administration (OSHA) standards and Centers for Disease Control and Prevention (CDC) recommendations form the foundation and best practices of procedures and protocols that drive this safety. Dentistry is a science that requires not only precision hand skills, but also accurate vision; thus, eye protection from all hazards is critical for a long, successful career of caring for patients.

Most providers are keenly aware of the risks of ocular injury and exposure from spray and spatter of patient oral fluids.

The OSHA Bloodborne Pathogens Standard states, “when splashes, sprays, splatters or droplets of blood or OPIM pose a hazard to the eyes, nose or mouth, then

Efficiency In Group Practice : ISSUE 6 • 2019

masks in conjunction with eye protection (such as goggles or glasses with solid side shields) or chin-length face shields must be worn.”1 The CDC concurs, stating, “dental health care personnel should wear protective eyewear with solid side shields or a face shield during procedures likely to

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generate splashes or sprays of blood of body fluids or the spatter of debris.”2

A new ocular risk With advances in restorative dentistry and the trend of placing composite restorations rather than amalgam, there is a new ocular risk providers must pay attention to: blue light.3 Light curing units (LCUs) are not only used for curing composite restorations, but also for bonding and tooth whitening, and the lights have become more intensified over time. Most adhesive materials found on the market today contain photoinitiators, material components that require absorption of optical radiation in the wavelength range ~350-500 nm to set. Light emitting diode (LED)-based curing lights are the most-used light sources with an emission peak in the blue/ blue-green range (430-490 nm).4 Quartz-tungsten-halogen (QTH) LCUs have dominated light curing of dental materials for decades and are now almost entirely replaced by modern LED LCUs. Visible LEDs were invented in the early 1960s.

Nevertheless, it was not until the 1990s that LEDs were seriously considered by scientists or manufacturers of commercial LCUs as light sources to photopolymerize dental composites and other dental materials.5 So, how does blue light affect the eyes of dental team members who use it? Blue light has the shortest wavelengths of all types of visible light (380-495 nm). Accordingly, blue photons have greater energy than photons with longer wavelengths, and high-frequency blue light is sometimes referred to as high-energy

visible light.6 Many studies have been done on ocular hazards of LCUs used in dentistry. A recent study by Alasiri et al was published this April, as a systematic review of online PubMed and Google Scholar databases. The objective of the study was to examine the literature and summarize studies that describe the potential ocular hazards posed by different systems of LCUs used in dental clinics to ensure the safety of the operator, patient and auxiliary staff. The results confirmed most of what is now widely known – that blue light radiation can cause moderate-to-severe retinal damage to both dental healthcare workers and patients who are exposed for long periods of time without wearing eye protection. Blue light has a higher energy and can penetrate to the back of the eye at the retina, which is susceptible to damage, risk of burning, enhanced retinal aging and, over time, macular degeneration.6,7,8 Along with blue light exposure of LCUs, many practices – especially large groups and DSOs – use electronic patient record systems. The use of computers, phones and other

devices with electronic displays are means of additional exposure of eyes to increased amounts of light stimulation. As phototoxicity contributes to the progression of retinitis pigmentosa and age-related macular degeneration, which are major causes of blindness worldwide, the influence of light on the retina is a public health concern.6 How much blue light from LCUs are dentists exposed to? While this differs based on each practice and provider, in a study of Norwegian dentists4, the researchers found they spent on average 57.5% of their working days placing restorations (ranging from 1 to 30 restorations per day). The average length of light curing for one normal layer of composite was 27 seconds. The longest individual mean curing time per day was approximately 100 times higher than that of the lowest. Almost onethird of the dentists used inadequate eye protection against blue light.4

Recommendations for eye safety to blue light Orange- and/or bronze-colored filters block blue light most effectively.

Orange filters cut out more blue

Graphic courtesy of Palmero Healthcare

ISSUE 6 • 2019 : DentalGroupPractice.com 33

/ Infection Control /

Graphics courtesy of Palmero Healthcare

light than bronze filters and block blue light wavelengths of anywhere between 385-495 nm. Therefore, it is possible to greatly reduce the effects of blue light on the eyes by ensuring that it has to pass through filters, such as functional protective eyewear that contain these colors.6 Where there is not specific guidance related to a worker hazard, the employer can invoke OSHA’s General Duty Clause as a strategy to mandate additional safety measures for employees. The General Duty Clause states, “each employer shall furnish to each of its employees a workplace that is free from recognized hazards that are causing or likely to cause death or serious physical harm.”9 Thus, any recognized hazard not covered in a standard, such as the Bloodborne Pathogens, is covered under the General Duty Clause and the employer must implement a References

Protecting clinicians’ eyes from blue light exposure of LCUs is just as important as protecting eyes from patient oral spray and spatter, but not as widely practiced or accepted.

feasible and useful method to correct the hazard, such as standard protocols to wear and use special orange filter eyewear to protect dental healthcare team members from potential ocular injury of blue light exposure.

Looking away from the light is not recommended; in many cases this behavior causes the curing light operator to move the light away from the restoration area, resulting in decreased light dose to the material, which may compromise restoration

quality.4 Currently, the most important recommendations regarding the use of blue light in dentistry are to read the manufacturer instructions for curing devices and to use radiation-filtering protection goggles.6 Protecting clinicians’ eyes from blue light exposure of LCUs is just as important as protecting eyes from patient oral spray and spatter, but not as widely practiced or accepted. Team members must be informed and educated on the hazards of long-term exposure to blue light, and as specific safety eyewear is indicated to reduce the potential of ocular injury from patient oral fluids, blue light filtering eyewear should be utilized to protect the eyes of team members during procedures involving LCUs. Employers and management teams must ensure compliance and keep up with appropriate safety protocols as dental materials and techniques continue to advance.

1. U.S. Department of Labor. Occupational Safety and Health Administration; Bloodborne Pathogens Standard. Available at https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS. Accessed September 17, 2019.

2. U.S. Centers for Disease Control and Prevention. Oral Health; Personal Protective Equipment. Available at https://www.cdc.gov/oralhealth/infectioncontrol/faqs/personal-protective-equipment.html. Accessed September 17, 2019.

3. Eklund, SA. (2010). Trends in dental treatment, 1992 to 2007. J. Am. Dent. Assoc., 141(4): 391-399.

4. Kopperud,SE., Rukke,HV., Kopperud,HM., Bruzell,E.M. (2017). Light curing procedures – performance, knowledge level and safety awareness among dentists.

Journal of Dentistry, 58: 67-73.

5. Jandt, KD., Mills, RW. (2013). A brief history of LED photopolymerization. Dental Materials, 29 (6): 605-617.

6. Yoshino, F., Yoshida, A. (2018). Effects of blue-light irradiation during dental treatment. Japanese Dent Sci Rev, 54 (4):160-168.

7. Alasiri, RA., Algarni, HA., Alasiri, Reem A. (2019). Ocular hazards of curing light units used in dental practice – A systematic review. Saudi Dent J, 31(2):173–180.

8. Ham, WT, Jr., Ruffalo, JJ, Jr., Mueller, HA., Clark, AM., Moon, ME. (1978). Histologic analysis of photochemical lesions produced in rhesus retina by shortwave-length light. Investigative Ophthalmology and Visual Science, 17(10):1029-1035.

9. U.S. Department of Labor. Occupational Safety and Health Administration. General Duty Clause. Available at https://www.osha.gov/laws-regs/oshact/ section5-duties. Accessed September 17, 2019.

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Efficiency In Group Practice : ISSUE 6 • 2019

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/ OSAP / Safe Dental VisitTM

OSAP Dental Infection Control Boot Camp™ The Organization for Safety, Asepsis and Prevention (OSAP) – a community of clinicians, educators, policy makers, consultants and industry representatives who advocate for the Safest Dental Visit™ – will host the OSAP Dental Infection Control Boot Camp™ in Chicago at the Chicago Marriott Downtown Magnificent Mile, Jan. 27-29, 2020. OSAP Dental Infection Control Boot Camp™ is a three-day, fast-paced educational course presented by national and international experts in dental infection prevention and patient safety. The course will provide a comprehensive review of all the basics in dental infection control, as well as offer 25-plus hours of CE credit plus a copy of the newly updated OSHA & CDC Guidelines: OSAP Interact Training System – a 6th Edition workbook with checklists, tools and more.

The course is designed for: • Infection control coordinators in busy dental practices.

• Educators responsible for infection prevention and safety instruction.

• Compliance officers in group practices and on dental boards.

• Federal service employees responsible for infection control in their duty stations.

• Federally Qualified Health Center (FQHC) personnel responsible for infection control.

• Consultants and sales representatives who want to demonstrate infection control competency.

Upon completion of this course, participants will be able to: • Describe disease transmission and principles of infection prevention and control in a variety of oral health care settings.

• Identify relevant infection control laws, regulations, guidelines, standards and best practices.

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Efficiency In Group Practice : ISSUE 6 • 2019

• Use quality assurance measures (e.g., direct observation and feedback) to ensure accurate implementation of recommended infection control practices.

Not only will participants leave the 2020 OSAP Dental Infection Control Boot Camp™ with new information, resources and products to help them better address infection prevention and safety challenges, they will meet new colleagues who share their interest in this critically important topic area.

On Jan. 26, 2020, from 2-5 p.m., Boot Camp will kick off with the TeamSTEPPS Pre-conference Workshop. A product of more than 25 years of experience with the Agency for Healthcare Research and Quality and the TeamSTEPPS curriculum, the workshop is designed to help break down communication barriers between healthcare professions.

The OSAP Dental Infection Control Boot Camp™ will follow the workshop and run: • Jan. 27, 7:30 a.m. – 4:30 p.m.

• Jan. 28, 7:30 a.m. – 5:30 p.m.

• Jan. 29, 7:30 a.m. – 4:15 p.m.

Information on the faculty, agenda and other details regarding the educational program will be posted at www.osap.org.

The U.S. Army, Navy and Air Force each will have additional training sessions on Jan. 30. Ranking officers will be required to attend and civilians employed by these branches will be encouraged to attend as well.

(Federal service dress codes are posted at www.osap.org).

Dental assistant scholarship OSAP is excited to present dental assistants attending the 2020 Boot Camp, a scholarship in memory of Anna Nelson, CDA, RDA, MA. Qualified applicants will receive: • 25% off the early-bird member rate for 2020 OSAP Dental Infection Control Boot Camp™ ($106.25 value).

• One free year of the OSAP Basic Membership (an online membership with a $75 value).

Dental assistants are encouraged to apply for this scholarship prior to registering. Scholarships are limited to 30 and will be awarded on a firstcome, first-serve basis, provided the eligibility requirements are met.

/ OSAP / Safe Dental VisitTM

Registration OSAP member registration fees apply to all membership levels, except for those with the Basic Membership (online membership). Registrants must log into their OSAP account to receive the member rate.

Additional registration information is coming soon and will be available at www.osap.org.

Questions about the program, logistics or registration should be directed to: Email: office@OSAP.org

2020 Dental Infection Control Boot Camp™ Jan. 27-30, 2020 – Chicago • Registration Registration Fees

Early-Bird Pricing Received After Received After by 10/31/2019 10/31/2019 12/15/2019

OSAP Members and Military/Federal Service Personnel

$425

$505

$665

Non-members

$625

$705

$865

Additional Attendees from Same Facility

$325

$405

$565

Cancellations and refunds

TeamSTEPPS Pre-Conference Jan. 26, 2020 – Chicago • Registration Registration Fees

Early-Bird Pricing Received After Received After by 10/31/2019 10/31/2019 12/15/2019

OSAP Members and Military/Federal Service Personnel

$75

$100

$150

Non-members

$105

$130

$180

To ensure we can accommodate your needs, please indicate your requirements on the registration form. If you have any questions, contact OSAP at office@OSAP.org.

The OSAP Dental Infection Control Boot Camp™ is the only course in the country that focuses solely on developing leaders in this critical topic. Potential exhibitors and sponsors who sell infection control or patient safety products will not want to miss it!

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CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Participants requesting professional CE credits will receive a CE verification form to record the CE numbers for the specific courses they attend. To receive CE credit, participants must sign in at the conference, attend the sessions, record the assigned CE number for each lecture attended (note: CE verification numbers are announced at the end of each session) and complete the required evaluation forms. Attendees will need to maintain their CE verification form as proof of participation in the educational programming.

Efficiency In Group Practice : ISSUE 6 • 2019

Phone: 410-571-0003 U.S. and Canada: 1-800-298-6727 Mailing Address: 3525 Piedmont Rd. Building 5, Ste. 300, Atlanta, GA 30305

Continuing dental education OSAP is an ADA Continuing Education Recognition Program (CERP) Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA

All registration cancellations and refund requests must be made in writing by Dec. 15. A 50% refund of conference fees will be given for cancellations received between Nov. 1 and Dec. 15. No refunds will be granted for requests postmarked after Dec. 15. Requests should be submitted to OSAP via email at office@osap.org.

OSAP regrets that refunds will not be given for no shows. All requests for exceptions to the cancellation and refund policy must be submitted in writing by the registrant with appropriate documentation no later than Dec. 15. After that, no refund considerations will be made.

Substitutions within this program will be accepted. Individuals may receive a substitution for a full registration prior to the conference by submitting a written request to office@osap.org. Onsite transfers will not be permitted. The individual submitting the substitution request is responsible for all financial obligations

(any balance due) associated with that substitution before the change can be made. Badge sharing, splitting and reprints will be strictly prohibited.

OSAP is not responsible for airfare, hotel or other costs incurred by participants in the event of a program or registration cancellation. As added protection against unforeseen circumstances, OSAP suggests travel insurance.

OSAP will offer registrants contact information to facilitate networking after the course. By registering, individuals give OSAP permission to

include their name and contact details on the attendance list. During the registration process, there is an option to opt-out of this attendance list. Alternatively, individuals who do not wish to be included on the attendance list should email their exclusion request to office@osap.org by Dec. 15.

OSAP takes photos during the course. By registering, participants give OSAP permission to use any images taken at the course in which they appear, as well as any written comments they submit on evaluation forms.

Code of conduct OSAP’s Code of Conduct outlines OSAP’s expectations for anyone attending or contributing to an OSAP meeting or educational activity, as well as the consequences for unacceptable behavior. If any participants are the subject of unacceptable behavior or witness any such behavior during conference events, they should contact Michelle Lee, OSAP’s Executive Director at 404-944-4824 or mlee@osap.org.

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

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Five Reasons Why Every Practice Needs a

WRITTEN INFECTION PREVENTION PROTOCOL

By Jessica Wilson, MPH, Global Business Development Manager, Hu-Friedy

EVERY DENTIST KNOWS THE CRITICAL importance of establishing infection prevention protocols to ensure the safety of both the patients and staff as well as the viability of the practice in general. What some dentists may not be aware of is that most states require specific written protocols that cover every aspect of infection prevention – from the obvious, like instrument reprocessing, to the not-so-obvious, like how to navigate a boil-water advisory. Getting it all recorded in writing is no easy task but having written infection prevention protocols can significantly benefit a practice beyond satisfying legal requirements. For DSOs and group practices, it is particularly important to know where infection prevention aligns and differs across practices.

The following five reasons show why every practice needs comprehensive written infection prevention protocols: IT’S A GREAT PRACTICE MANAGEMENT TOOL CDC guidelines state that all practices should designate an infection control coordinator (ICC) – someone who is knowledgeable about infection control and willing to be educated above and beyond to ensure their practice complies with the latest patient safety standards and guidelines. The ICC is a fantastic resource and should be a key driver in the development and implementation of an effective infection prevention program for dental practices.

1

As much as the ICC is there to help ensure team members have access to current, relevant information, infection prevention is a team sport that requires the participation of everyone working in the practice. Written protocols serve as a benchmark for program execution and are a great tool to ensure proper practice management across the whole team in this area. With a digital version, dental practices can do their part in the green movement while the benefits of the digital protocols can be expanded across multiple locations so team members across offices are all working in unison.

IT HELPS PROTECT FROM DISCIPLINARY ACTIONS It almost goes without saying, but the majority of infection prevention patient safety breaches are preventable with the right solutions and processes in place. In fact, one of the more common violations is simply not having a written protocol. Developing written protocols is complex, but it’s still the quickest and easiest way to create a path for a fully compliant practice. Written protocols are a standard in any business practice and are the foundation for an effective patient safety program.

2

IT CAN REALLY HELP WITH TRAINING AND ALIGNING NEW EMPLOYEES Starting a new job is universally stressful, and when a new employee joins a dental practice, they must under-

3

stand culture, procedures, and processes that are unique to that particular practice. However, this goes both ways, and many practices allow new employees to bring bad behaviors with them from other work environments that may not reflect evidence-based guidelines for infection prevention and safety. Set the stage by providing a professional, detailed representation of your practice standards. Ultimately, an office’s infection prevention program is only as good as the newest “greenest” staff member.

Without proper training facilitated by written step-bystep protocols, their bad habits can ricochet throughout the practice with speed.

IT HELPS BUILD GOOD HABITS FOR INCREMENTAL PRACTICE IMPROVEMENT All too often, dental professionals approach infection prevention incorrectly because “that’s the way I was trained, so what’s wrong with it?” not knowing that their training is not aligned with appropriate standards for infection prevention. As a result, most practices don’t even know they’re in violation until it’s too late. Even with the best intentions, it’s likely that practices without written protocols will stray from the appropriate processes over time, much like a bad game of “telephone.”

Written protocols instill a sense of accountability and help ensure that good practices are maintained over time and that dental offices have a point of reference for a good foundation.

4

ter advisory, for instance, a practice cannot reference their OSHA manual to find protocol on how to manage that. OSHA does not regulate water, the EPA does! Can you confidently expect your team to know such detailed information off-hand? A written protocol can help practices navigate the complicated minutiae of infection prevention in any scenario. This is particularly important for DSOs or group practices that may have offices in different states. Written protocols provide the clarity needed to enable offices to practice compliantly.

HOW TO DEVELOP WRITTEN PROTOCOLS Writing out your protocols might feel like a daunting task, given the complexities of infection prevention, but it is well worth the effort.

Many dental practices are moving away from paper and going paperless! Today, there are great digital resources available to help practices develop and maintain up-todate protocols customized for their office. GreenLight Dental Compliance Center®

by Hu-Friedy, for example, compiles access to regulatory info, recommendations for best practices, task schedules, CE training modules, and other relevant components of a compliance program into one comprehensive online portal. With digital protocol templates, it’s easy to customize protocols for any practice, incorporating state board requirements, CDC guidelines, and OSHA as it relates to infection prevention. After the protocols are complete, simply train and implement with the dental team and track comprehension and compliance.

It almost goes without saying, but the majority of infection prevention patient safety breaches are preventable with the right solutions in place.

IT PROVIDES CLARITY IN NAVIGATING REGULATORY GUIDELINES The infection prevention regulatory landscape in dentistry is complex and confusing, with protocols that can derive from multiple regulatory bodies. The CDC, OSHA, and state dental boards provide the bulk of regulations, but not all for dental practices. In the event of a boil-wa-

5

While infection prevention is something the entire team is responsible for, it’s up to the practice owner and organization leadership to set the tone with appropriate standards. Written protocols go a long way towards accomplishing that by removing complexity and establishing a replicable approach. If you’re practice doesn’t have written protocols, consider making it a priority today. ■

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The GreenLight Dental Compliance Center helps you create customized infection prevention and instrument reprocessing protocols and internal audits, so you are prepared and protected.

GreenLight also saves time on staff training and updates, with improved performance in your infection prevention practices.

You’ll find more than convenience with GreenLight — you’ll also gain the confidence that comes from knowing your facilities are in compliance.

Learn how to start improving your compliance at GreenLightComplianceCenter.com.

/ Leadership /

Organic Organizational Effectiveness Three leadership imperatives from The Biggest Little Farm It’s not nice to fool Mother Nature.

If you’re old enough to remember this ad campaign, you’re probably also old enough to remember when people threw trash out the car window and kids could follow chemical trucks spraying for mosquitoes. For younger readers, this alternative universe was called the 1970s.

Flash forward to today, where the balance between ecosystem and commerce is a subject of fierce debate.

But what if instead of trying to balance nature and commerce, we looked to Mother Nature as a model of organizational effectiveness.

My new favorite movie is “The Biggest Little Farm,” a feel good film that chronicles the eight-year quest of two idealists, Molly and John Chester, as they trade city living for 200 acres of barren farmland and a dream to harvest in harmony with nature.

The Biggest Little Farm provides three big insights for leaders:

1. Verbalize your vision and share it often Molly Chester’s vision to run a traditional foods farm was rooted in her training as a natural food chef. Her passion inspired (persuaded) her husband filmmaker John Chester to help find investors and purchase Apricot Lane Farms, an endeavor most of their friends thought was crazy. The film is an intimate look inside the lives of two young people

By Lisa Earle McLeod

more than 75 types of fruit and cover crops to keep soil in place. During the course of a few years, their soil became richer, and when heavy rains hit, Apricot Farms didn’t lose mountains of dirt to runoff as other farmers did. When you find people who have studied your field, listen to them. You’ll save years of frustration.

3. Don’t cave on principles but get creative with resources instead who start out naively. Yet, as the film’s website says, “Through dogged perseverance and embracing the opportunity provided by nature’s conflicts, the Chesters unlock and uncover a bio-diverse design for living that exists far beyond their farm, its seasons and our wildest imagination.”

Without a vision, the Chesters would have been simply scratching away at the dirt trying to make ends meet. Molly’s vision kept them going and inspired others to join their cause. Verbalizing your dream often keeps it real.

2. Find good mentors and invite them to participate After buying 200 acres of neglected land in Moon Park, Calif., the Chesters ask farming guru and bio-dynamic consultant Alan York to help them. York challenged them. Instead of planting one or two crops, as most farms do, York recommended diverse orchards with

Watching pests destroy the Chesters’ hard-won progress is heartbreaking.

During a snail invasion, John asks Molly, “I don’t suppose we can use chemicals?” She responds, “No, we’re not.” Lesser leaders would have called in a chemical truck.

Instead, the Chesters solve the problem by cross-training their animals – no joke. I don’t want to ruin the surprise but ducks are involved.

It’s ecofriendly and it’s hilarious.

I never dreamed I’d cry over a farm movie but I did, and so did my big, strong husband who says, “I loved the transformation. Watching them turn something almost like a dust bowl into something so lush, beautiful and bountiful was stunning.”

Mother Nature shows us for every action there is an equal and opposite reaction. If you kill off one thing, it’s going to impact something else. But if you’re willing to nurture and grow your dreams, they will affect everything and everyone around you.

About the author: Lisa Earle McLeod is a leading authority on sales leadership and the author of four provocative books including the bestseller, “Selling with Noble Purpose.” Companies like Apple, Kimberly-Clark and Pfizer hire her to help them create passionate, purpose-driven sales organizations.

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Efficiency In Group Practice : ISSUE 6 • 2019

“Small violations can have

big consequences.

What could I be missing?”

STAYING COMPLIANT

IS MORE CRITICAL THAN EVER. Managing infection prevention standards and guidelines at multiple offices is no easy task. The number of standards and guidelines outlined by organizations like the CDC, state dental boards, and OSHA can be overwhelming, and every office is held to a high level of accountability. To have an effective infection prevention program, staff members must be thoroughly trained and committed to following the right steps every time. Because there is no “good enough” — only compliant or noncompliant.

Change the way your offices look at infection prevention with the GreenLight Dental Compliance Center by Hu-Friedy. This exclusive, one-of-a-kind resource keeps all of your infection prevention guidelines and regulations conveniently housed in one portal. With GreenLight, you can easily assess, improve, and maintain compliance at your offices.

Get started on the path to increased compliance by visiting GreenLightComplianceCenter.com

©2019 Hu-Friedy Mfg. Co., LLC. All rights reserved. [954] GL-006/1019

/ Sponsored / MouthWatch

Teledentistry: Key to engaging patients When patients can’t come to the office, Paul Labbe, DDS, brings the office to his patients

From the start of his career, Paul Labbe, DDS, owner of Texas-based Planet Dental, has made it a point to give back to the community. With four offices and a quality team of dental professionals strategically located in an underserved area of Southern Texas, it would appear he’s in a position to provide some deeply needed care. As he discovered, however, patients in need can be difficult to reach – that is, until he added teledentistry to his practice.

“The best part about this profession is the ability to give back to any community,” says Dr. Labbe. “In dental school, I had the opportunity 44

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to participate in several outreach programs, including a mission trip to Fiji, where we set up a clinic in a remote village and provided oral hygiene

services, oral surgery, limited removable prosthodontics, direct glass isomer restorations and limited root canal services. I also was involved in a program that delivered dental care to the homeless in San Francisco.”

When he established his practice in the Laredo, Texas, area, for the most part he focused on treating underserved children. “Unfortunately, the parents of these children would habitually break dental

appointments and usually only visited our office when their children’s caries were visible and at a rampant state,” he says. It was then he became aware of TeleDent™, a turnkey teledentistry platform by MouthWatch. “By utilizing TeleDent in our offices, we have been

able to develop a screening program that includes local health fairs and school outreach events, making it possible to perform dental screenings in schools without using radiation to assess caries risk, identify decay and abscesses, or determine hygiene classifications.

“ Before we had teledentistry, unless patients were in our office, we could not provide any caries risk assessment or recommendations.”

Dr. Paul Labbe

– Paul Labbe, DDS, owner of Texas-based Planet Dental

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/ Sponsored / MouthWatch

Bringing awareness to the community Dr. Labbe’s screening program, which is integrated with several local schools, is bringing awareness to parents and their children who otherwise might not visit a dentist, he notes. “This absolutely has had a positive effect on the community,” he says. “In fact, without teledentistry, it would be nearly impossible to reach these patients. “

“Before we had teledentistry, unless patients were in our office, we could not provide any caries risk assessment or recommendations,” says Dr. Labbe.

“Today, with the help of a laptop, the TeleDent app, a MouthWatch intraoral camera, gloves and mirrors, we can screen for visible caries, infections, calculus and plaque buildup, eruption anomalies, mal occlusions and more. Essentially, we are able to take the diagnostic portion of the

exam (excluding radiographs) outside of the office, and educate children and adults about their oral health.” Now Dr. Labbe and his team can share images with patients and their parents, which help them explain the diagnosis and recommendation. “As a result, our patients and their parents are much more engaged in their appointments and more willing to comply with treatment recommendations!”

Teledentistry at a glance Teledentistry is helping dental practices expand their private model, notes MouthWatch CEO Brant Herman.

“Our all-in-one teledentistry platform, TeleDent™, is a prime example,” he says. A secure, cloud-based, easyto-use system, TeleDent is feature-rich and highly scalable, and offers the following benefits, he points out: • Efficient communication. Better communication throughout a dental practice means greater collaboration among team members.

• Improved patient care. Efficiently treating patients facilitates more predictable, positive patient outcomes and an elevated standard of care.

• Convenient consultation. TeleDent makes it easier for them to consult with patients – either in real-time or via store and forward-file and exam sharing.

Editor’s note: Sponsored by MouthWatch.

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• Increased patient case acceptance. TeleDent helps clinicians visually explain to patients why they need treatment, particularly for complex cases.

• Enhanced patient experience. From the initial virtual consultation to treatment completion, doctors and their dental team can offer patients a more enjoyable experience, leading to greater patient retention.

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/ Industry News /

DSOs, DENTAL PROVIDERS AND INSURANCE NEWS Smile Brands, A+ Dental Care partner to expand dental services in Natomas, CA Smile Brands Inc. (Irvine, CA), with its affiliate A+ Dental Care, announced the acquisition of Dr. Glenn Misono (Natomas, CA) and the opening of a new A+ location in Natomas. Dr. Glenn Misono has served the community for over 16 years. The practice will be rebranded as A+ Dental Care. A+ Dental Care is a rapidly growing group dental practice with seven locations across the Sacramento area. The group’s 14 general dentists and three specialists provide comprehensive, personalized dental care.

Carolina Family Health Centers receives $300K HHS grant for mobile dental care unit Carolina Family Health Centers (Wilson, NC) received a $300,000 grant from HHS to purchase a mobile unit and expand dental healthcare. The mobile unit will take about 8 months to build. When complete, it will be equipped for dental screenings, X-rays, cleanings and procedures. The bus will also have space for medical care such as immunizations and physicals.

Missouri county health department opens its first dental clinic The Missouri Health Department opened its first dental clinic in Dade County on Oct. 15. The new clinic will accept non-insured individuals, along with

those with insurance or Medicaid. County residents previously had to drive up to 30 minutes to see the county’s only dentist.

Pacific Dental Services-supported dentist joins Virginia dentistry board Michael Nguyen, DDS, was appointed to the Virginia State Board of Dentistry. The Virginia Board of Dentistry oversees licensed individuals who provide dental services within the state. As a board member, Dr. Nguyen will also review complaints against licensed dentists and unlicensed individuals. Dr. Nguyen is a dentist at the Dentists of Gainesville and Dentists of Sterling. His practices are supported by Pacific Dental Services (Irvine, CA), which supports more than 750 dental offices across the U.S.

Group of four Minnesota practices forms new group, Mosaic Dental A group of four dentist offices have consolidated to create Mosaic Dental (Burnsville, MN). The group was formed from offices in Apple Valley, Burnsville and Eagan, Minnesota. The Mosaic model draws on the strengths of skills of four metro practices with a key differentiation being that local dentists retain ownership of their practice, while taking advantage of resources that only larger groups have been able to provide in the past, local news reported.

U.S. GOVERNMENT AND REGULATORY TRENDS

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HHS gives Florida health centers $4.6M for dental care

FDA to review safety of metal implants, dental alloys

Sixteen of Florida’s community health centers have received grants to advance oral healthcare from HHS. The funds will be used to upgrade equipment, provide more integration between oral health services and primary care at the health centers, and expand service sites across the state. In total, HHS is investing $4.6 million across the nation to expand patients’ access to dental care. Federal funding for early detection and preventative dental care could decrease ER visits and the overall healthcare system cost, the ADA reported.

The FDA announced it will evaluate metals used in implants and amalgam dental fillings to determine whether the devices are safe and effective. The announcement comes after several reports of adverse reactions to devices containing metal.

Current evidence suggests that some people may be more susceptible to contracting an immune or inflammatory reaction when exposed to certain metals in implanted devices.

Symptoms can be limited to the region where the device is or more generalized. Reported systemic symptoms include weakness, fatigue, rash, and joint or muscle pain.

Efficiency In Group Practice : ISSUE 6 • 2019

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