First Impressions Aug 2018

For Dental Professionals June, 2010 A partnered publication withSales Dental Sales Pro • www.dentalsalespro.com

For Dental Sales Professionals

A Guide to Sterilizers When sales reps know the facts, they can offer their customers the best possible solutions

August 2018

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FOR DENTAL SALES PROFESSIONALS

A Guide to Sterilizers

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When sales reps know the facts, they can offer their customers the best possible solutions

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An Eye on the Future

Atlanta Dental builds on its 150-year-old heritage with a forward-thinking approach to supporting dentistry.

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17 The Ideal Cure

As curing technology has become increasingly sophisticated, curing lights have become more and more diverse, leading dentists to question which light solution and bulk fill composite best meets the needs of their practice.

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At Their Service

Eric Meiners is driven to help others, whether he’s providing service to his dental customers, volunteering with his local fire department or bringing his skills to post-war Liberia.

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AUGUST 2018

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Editor’s Note

Clean Machine

A Clean Finish

A high quality prophy paste leaves patients with a clean, polished feeling

Sterilizers: Solutions that Work

Increased awareness of infection control drives sterilization in dentistry.

Steri-centers

A carefully planned sterilization center makes it easier for the dental practice to adhere to safe sterilization protocols.

Reprocessing Dental Handpieces Compliance with CDC guidelines for reprocessing is vital to the safety of the dental staff and patients.

The Right Cure Reliable Results Windshield Time

Automotive-related news

Quickbytes

Technology News

Healthy Rep

Health news and notes

News

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First Impressions

August 2018

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EDITOR’S NOTE

LAURA THILL Editorial Staff Editor Laura Thill lthill@ sharemovingmedia.com

Clean Machine It wasn’t long ago that infection control was pri-

marily hospital talk. Not anymore.

Thanks to the CDC guidelines and FDA recommendations around sterilization protocols, your dental customers are more aware of infection prevention than ever before.

Sterilization protocols have come to play an increasingly central role in their practices, according to Sarah Seaton, Manager Instrument Processing, Midmark Corp. For office design and equipment specialists, sterilization centers have become an integral part of any office setup. For dental professionals, sterilization is key to the safety of their staff and patients.

In this issue, experts share selling tools to help you provide your customers with sterilizer solutions that address workflow and ensure efficiency and effectiveness. They familiarize readers with various sterilization protocols and the CDC guidelines that define these protocols. They demonstrate that the sterilization center encompasses far more than the sterilizer alone, as Seton points out.

And they show you how to convey to the entire dental team the importance of adhering to CDC guidelines for instrument processing.

“Instrument reprocessing is a complex process requiring approved equipment, packaging, processing space and knowledgeable/ qualified clinicians to perform the procedure,” says Leann Keefer, RDH, MSM, director, corporate education & professional relations, Crosstex International, a Cantel Medical com– Sarah Seaton, Manager pany. “The better distributor sales reps know Instrument Processing, Midmark Corp their dental customers, the easier it is to offer them solutions designed to help their practices run efficiently and safely and comply with the necessary recommendations and guidelines.” The size of the practice, the number of patient appointments scheduled each day and the volume of instruments that must be processed all factor into equipment selection.

And, it pays to work with a credible manufacturer that can deliver a top-notch product, a solid warranty and dependable technical support. “Dentists look for reliability in sterilizer brands they trust,” says Seaton. “Sterilization is a critical function of their practice. If their instruments are not sterile and ready for use, they cannot serve their patients’ needs.”

“ Dentists look for reliability in sterilizer brands they trust.

Sterilization is a critical function of their practice. If their instruments are not sterile and ready for use, they cannot serve their patients’ needs.”

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Managing Editor Graham Garrison ggarrison@ sharemovingmedia.com Founder Brian Taylor btaylor@ sharemovingmedia.com Senior Director of Business Development Diana Craig dcraig@ sharemovingmedia.com

Director of Business Development Jamie Falasz, RDH jfalasz@ sharemovingmedia.com Art Director Brent Cashman bcashman@ sharemovingmedia.com Circulation Wai Bun Cheung wcheung@ sharemovingmedia.com Weekly Drill Editor Alan Cherry acherry@ sharemovingmedia.com

First Impressions is published bi-monthly by Share Moving Media 1735 N. Brown Rd. Ste. 140 • Lawrenceville, GA 30043-8153 Phone: 770/263-5257 • Fax: 770/236-8023 www.firstimpressionsmag.com

First Impressions (ISSN 1548-4165) is published bi-monthly by Share Moving Media., 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2018 by Share Moving Media. All rights reserved. Subscriptions: $48 per year. 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 publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors.

First Impressions editorial advisory board Shannon Bruil, Burkhart Dental Frank Cohen, Safco Steve Desautel, Dental Health Products Inc. Nicole Fox, Patterson Dental Suzanne Kump, Patterson Dental Dawn Metcalf, Midway Dental Supply Lori Paulson, NDC Patrick Ryan, Benco Dental Co. Scott Smith, Benco Dental Co. Tim Sullivan, Henry Schein Dental

Clinical board Brent Agran, DDS, Northbrook, Ill. Clayton Davis, DMD, Duluth, Ga. Sheri Doniger, DDS, Lincolnwood, Ill. Nicholas Hein, DDS, Billings, Mo. Roshan Parikh, DDS, Olympia Fields, Ill Tony Stefanou, DMD, Dental Sales Academy

WHAT YOU MAY HAVE MISSED

A Clean Finish A high quality prophy paste leaves patients with a clean, polished feeling

Patients desire the fresh, clean feel of polished teeth. Indeed, a bitter aftertaste may be all it takes to deter them from returning for their next cleaning!

With the right prophy paste, dental professionals can deliver the experience and results their patients expect.

Research supports that keeping teeth free of plaque and calculus is one of the best ways to prevent periodontal disease. A regular professional prophylaxis – or cleaning – using a polishing paste containing an abrasive, such as flour or pumice, to remove dental biofilm and extrinsic stains from the coronal surfaces is an important component of a healthy oral hygiene regimen.

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But, not all prophy pastes are the same, according to experts. The handling characteristics, consistency and flavor quality of the paste can influence both professional and patient acceptance.

Hygienists seek a low-splatter, flash-rinsing paste that leaves a clean surface, while patients look for a fresh, clean, smooth mouth feel, a pleasant taste experience and shiny, stain-free teeth. While most products make these claims, not all deliver, often resulting in a less-than-positive experience for both the clinician and patient.

Less mess, better feel, greater variety Prophy pastes today are designed to enhance the dental experience – both for hygienists and their patients. Manufacturers, for instance, have added a variety of new flavors in addition to traditional mint and bubblegum. Younger patients in particular can enjoy the wide selection, leaving them with a positive feeling about their dental visits for many years to come.

Manufacturers have also worked to deliver prophy pastes less prone to splatter and grit. In the past, excessive splatter has made for a messier prophylaxis, as well as increased the risk of cross contamination and resulted in longer cleaning and preparation time between patients. And, patients have been known to complain of excessive grittiness, which can be deflating for hygienists striving to provide the best possible experience. Indeed, an easy chair experience and a smiling, satisfied patient can be the greatest validation of a job well done.

In recent years, many manufacturers have also placed additives, such as xylitol and calcium phosphate, in their paste to redeposit the building blocks of the tooth enamel. While many experts agree these are desirable ingredients, clinical studies have yet to support their therapeutic benefit.

Manufacturers, for instance, have added a variety of new flavors in addition to traditional mint and bubblegum. Younger patients in particular can enjoy the wide selection, leaving them with a positive feeling about their dental visits for many years to come.

Experts recommend that dental professionals sample products prior to purchasing them. Experiencing the paste’s performance in their hands and taking time to assess their patients’ reaction to the taste and feel of the paste can be key to providing predictable and desirable clinical outcomes.

A good investment A box of prophy paste can range from $15 to $65 for a box of 200 cups – the equivalent of paying just 7 to 37 cents for a 2-gram cup. But, saving a few pennies up front may not benefit the dental practice in the long run. While all prophy pastes contain the same active ingredients, the packaging, functionality, handling and flavor quality of lower grade products are often less than satisfactory for both professionals and their patients. One of the last things patients experience before leaving their dental visit – and scheduling their next appointment – is the taste and clean mouth feel of the prophy paste. A pleasant taste and a good feeling are much more likely to bring them back for a return visit.

Engage your customers When initiating a discussion about prophy pastes with dental customers, it’s important to discover what brand of paste they currently are using. From there, sales reps should ask several probing questions, such as: • “How long have you been using this particular brand of prophy paste?”

• “How often do you purchase new pastes?” (This will help determine whether your customers would like to take advantage of a quantity discount.)

• “What do you like about it, and what would you like to improve?”

• “Do you offer flavor choices for both adult and child patients?” (Your customers may wish to purchase more flavor varieties to enhance their patients’ prophy experience.)

• “How do your patients respond during treatment?

Do they remark about their clean, fresh mouth feel or a gritty feel and a bitter aftertaste?”

Editor’s note: First Impressions Magazine would like to thank Preventive Technologies, Inc. for its assistance with this article.

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August 2018

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SPONSORED

NORDENT

Looking Sharp

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

The hygiene appointment

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

All scalers and curettes, of any manufacture and any material, get dull with use and need to be sharpened. Scalers and curettes that are coated with titanium nitride (thin, gold-colored material) cannot be sharpened and must be discarded and replaced when they become dull. Some scalers and curettes are made from more advanced formulations of stainless steel, such as Hu-Friedy EverEdgeÂŽ and Nordent XDURAÂŽ, and stay sharp longer than tradition stainless steels. However, these products will still dull with use and need to be sharpened.

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Therefore, keeping the instruments sharp becomes one of the greatest challenges for hygienists in every practice.

Start a discussion

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

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

For most offices, the biggest challenge is TIME. As hygienists are required to provide a broader spectrum of treatment options and offices have become more focused on productivity, the demands on hygienists’ time have increased and maintaining regularly scheduled instrument sharpening has become challenging. When asked, many hygienists will say that they sharpen when they can or when they have a cancellation. However, many dentists and office managers require hygienists to make patient recalls or manage other activities during cancellations. Often, the result is that hygienists begrudgingly get used to working with dull instruments, and patient care and productivity suffers.

Nordent has developed a solution that fits today’s real world of dentistry. All Nordent XDURA and Relyant® scalers and curettes come with free, unlimited, professional sharpening for life. That means that at any time, an office can send their XDURA or Relyant scalers to Nordent and they will be professionally sharpened, free of charge.

Nordent also offers professional sharpening for all brands of instruments, in order to provide offices with a complete, hands-off solution.

In addition, when XDURA or Relyant scalers become too thin to use, they can be traded in for a new instrument at a 40 percent discount; these trade-in instruments also come with free sharpening. Over the past five years, Nordent has developed a system and materials to make the process fast and easy. They even provide a 24-hour in-house turnaround. Many offices have found that with the XDURA or Relyant system, they can ensure they are always using sharp instruments, they save time and frustration in the office, and they are able to devote more time to focusing on patient care.

Nordent also offers professional sharpening for all brands of instruments, in order to provide offices with a complete, hands-off solution.

Sales reps can engage their dental customers in a discussion about hygiene instruments by asking a few probing questions: • “Do you mind sharpening your hygiene instruments?”

• “How often does it take for you to thoroughly sharpen each instrument?”

• “How would having sharper instruments on hand help you do your job more efficiently?”

• “How do you handle replacing your instruments?

Do you prefer to purchase a couple of instruments at a time, or many all at once?”

• Have your curettes transformed into scalettes?”

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August 2018

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DISTRIBUTION

An Eye on the Future Atlanta Dental builds on its 150-year-old heritage with a forward-thinking approach to supporting dentistry.

Atlanta Dental (Duluth, Ga.)

may have a 150-year history, but its heart is in the present and its eyes are on the future. “We are a company that still has ground floor opportunities,” says Tom Richardson, president. “We are growing and plan to add experienced professionals that desire an environment where they can serve their customers at the highest level, with the support of the company behind them. We are a company with very strong field representation and an inside team that supports both our customers and our territory managers.”

Visitors new to Atlanta Dental are likely come away with a much different perception of the company than they expected.

“They might anticipate that a 150-year-old company is too traditional and stands only on its longevity,” says Gary Kirkus, CEO. “But, that changes as soon as they walk into the building and meet our professional team. They can see we are technology focused, with an efficient, modern facility.”

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Kirkus, Richardson and their staff of 187 (including 53 territory managers and eight equipment specialists) have a passion for products and services that support the dentist in both the clinical and business areas of the practice. “We have made it our commitment to do everything we can to help our customers improve and protect their practices,” Kirkus points out.

Supporting customers across the board If anything has stayed the same at Atlanta Dental in the past century-and-a-half, it’s the company’s mission, according to Richardson. The distributor places a premium on respect, customer focus and teamwork. “As such, Atlanta Dental emphasizes

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accountability for its performance,” he says. At the same time, “the company depends on a sense of innovation. This means always seeking new and better ways to meet the needs of the private practice during challenging times.”

“This is our motivation for developing and introducing PracticeLife at the Hinman this year,” says Kirkus. “It gives our team the opportunity to bring more value through a network of partnerships and services designed to help manage, grow and protect our customer’s practice. Our sales team is known for assisting with inventory control, supply audits and a focus on overhead reduction.”

“We also want to share ideas for increasing profitability and avoiding monetary loss,” adds Richardson.

That said, Atlanta Dental blends services, new products/technology and online ordering with personal face-to-face

“This is a company that believes in its commitment to the advancement of dentistry. Part of our heritage includes continuing the positive traditions of our company that are timeless.

Relationships matter.”

– Gary Kirkus, CEO

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service. “When our customers call or walk in our front door, they are greeted by a receptionist, not a recording,” says Kirkus. “We still call on our customers regularly to support their success and assist with areas of their practice where we can make a difference.”

“Our service, technology and installation teams are the best,” says Richardson. “Our response times are fast, and we can assist an office with virtually any need that arises. From installation and training on a cone beam system, to a leaky syringe and everything in between, our trained technical team excels.”

“Every visit or call with the dentist or their team is an opportunity to make a good impression,” says Kirkus. It helps that their sales team does not have a preconceived notion of what each dentist needs, he points out. They understand the importance

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DISTRIBUTION

of communicating with each office to assess their needs, in order to make proper recommendations that will serve them down the road. Particularly, as technology continues to advance, dentists will rely on their distributor reps for consultative services, he notes. “A trusting relationship between our reps and their customers is becoming even more important,” he says.

with traditional impressions. But we offer a great milling solution utilizing eMax from Ivoclar, as well as other materials. The decision needs to be based on preparedness and understanding and cannot be assumed.”

In addition, Atlanta Dental supports an extensive range of products, notes Kirkus. “We are very fortunate to represent nearly every major vendor,” he says. “We do not dictate product selection to our customers. We have options for every need and ensure the manufacturers we promote will assist us in backing up the recommendations we make. We are committed to doing everything we can to help make our dental customers’ every investment a success.”

Not a family business

Tom Richardson (President), Gary Kirkus (CEO), and David Blackshear (Chairman Emeritus)

“We understand that dentists do a lot of their own research online,” Richardson explains. “But, they often realize that the online answers don’t work in their practice. They need someone knowledgeable to help review their findings before making a final decision. I don’t think that need ever will change.” The advent of technologies such as cone beam, digital impressions, CAD CAM, and 3D printing “heralds a new era in dentistry,” he notes.

“More than ever before, dentists today need someone they can trust to help them navigate new advancements,” says Richardson. “They need someone who will clearly tell them what their total investment will be and show them a realistic ROI. We don’t assume that all offices need to own a mill, even though we see the convenience, accuracy and patientacceptance of digital scanning. The best option for many offices is to send their scans to the same lab they have trusted

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“We understand that dentists do a lot of their own research online. But, they often realize that the online answers don’t work in their practice.

They need someone knowledgeable to help review their findings before making a final decision.”

– Tom Richardson, president

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Atlanta Dental may consider its employees a family of sorts, but family-run it is not. “We are a privately-held, 100 percent employee-owned company,” says Kirkus. “We have 31 stock holders, and employees must work actively within the company in order to own stock.”

The company was founded in 1868

by Samuel Hape, a dentist who graduated from dental school when Abraham Lincoln was president. After opening a new dental practice in Atlanta, Georgia, he quickly recognized the city’s need for a dental supply company and started The Atlanta Dental Supply Company. He eventually was joined in business by Dr. Robert Holliday, a cousin of the infamous “Doc” Holliday.

Since its early days, the company has transitioned ownership to successive generations, with a commitment to remaining privately owned. “Our mission now is preparing the next generation of those who will own Atlanta Dental, keep it independent and not sell it to another company,” says Kirkus.

Business as usual Atlanta Dental continues to focus on its relationships, not just with its customers, but with its manufacturer partners and

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its employees. In fact, when hiring new team members, Kirkus and Richardson look for people who value relationships, making it easier for them to blend with their team. “Atlanta Dental does not consider sales reps solely based on their ability to sell,” says Richardson. “We look for relationship-focused reps who will care about our customers and help the dental office make purchases that meet their budget, as well as avoid making unnecessary purchases. These relationships aren’t built overnight. They require patience and persistence.

“We look for a strong work ethic,” Richardson continues. “We need reps who are available when the dentist needs them, whether it is 6 a.m. or 7 p.m. Our reps must maintain a strong focus on doing what is right, even when that may be inconvenient, in order to satisfy the need of a customer.”

• Provides a team of equipment and technical specialists who are available to support sales reps and dental customers. (“One of our strengths is the technical service support we offer dentists,” says Kirkus.)

• Meets regularly with manufacturer partners to stay informed with their new products and programs.

“ Our mission now is preparing the next generation of those who will own Atlanta Dental, keep it independent and not sell it to another company.”

“Part of our success is helping our reps stay up to date on all that we have to offer,” says Kirkus. To accomplish this, the company: •C onducts regular sales meetings, bringing in manufacturers and partners to keep the team current on the latest products, technology and services.

Kirkus and Richardson express gratitude for the growth Atlanta Dental continues to experience and for the attention its 150th anniversary has drawn. That said, they remain focused on the future, including opportunities to bring more value to the dental offices they serve. “This is a company that believes in its commitment to the advancement of dentistry” says Kirkus. “Part of our heritage includes continuing the positive traditions of our company that are timeless.

Relationships matter.”

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A Guide to Sterilizers When sales reps know the facts, they can offer their customers the best possible solutions

Selecting the right

sterilizer for a dental practice depends on several factors, including the size of the practice, the number of patient appointments scheduled each day and the volume of instruments that must be processed. The better distributor sales reps know their dental customers, the easier it is to offer them solutions designed to help their practice run efficiently and safely and comply with the necessary recommendations and guidelines.

It pays to work with a credible manufacturer that offers a solid warranty and dependable technical support, note experts. Additionally, sales reps must determine whether a dental practice requires multiple sterilizers, or simply a larger capacity model, according to Leann Keefer, RDH, MSM, director, corporate education & professional relations, Crosstex International, a Cantel Medical company.

They should explore with their customers how much space – and what footprint – the practice has for a dedicated sterilization area.

Sales reps must understand how the sterilizer will be used, she explains. For instance, how will dental instruments be packaged

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and loaded into the sterilizer? Does the practice use paper/plastic sterilization pouches and/or instrument cassettes with sterilization wrap? Each sterilizer chamber has a set weight and volume of instruments, she points out. Therefore, the dental practice may require a sterilizer that offers a variety of cycle capabilities to sterilize various types of loads through adjustments in time, temperature and pressure at each cycle phase and ensure compliance with Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) guidelines.

A complex process “Instrument reprocessing is a complex process requiring approved equipment, packaging, processing space and knowledgeable/qualified clinicians to perform the procedure,” says

Ask them “What day do you ConFirm®?”

Your customers want total sterility assurance—and you can deliver it.

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Remind them that Crosstex® offers a one-stop assurance solution, protecting patients and practices with per-load, daily, and weekly consumables. The Crosstex ConFirm® family of biological monitoring services and sterility assurance products provide is a complete system for the highest level of sterility assurance!

The gold standard of sterility assurance is biological monitoring of sterilizers at least once weekly. So ask your customers—what day do they ConFirm?

Because You Can’t See Sterile.® Visit CrosstexBMS.com for additional resources and education.

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Time Temperature Steam

STERILIZATION

Accessories for sterilizers In addition to providing their dental customers with the best sterilization solutions, distributor sales reps must ensure the practice is equipped with necessary accessories, including the following: • Paper/plastic sterilization pouches with built-in external/internal multi-parameter indicators. Dental practices may require a variety of sizes of pouches.

• Crepe sterilization wrap with the appropriate chemical indicators and tape for wrapping packs/cassettes.

• ASTM D4236 wet pen/marker, which is validated for writing on sterilization packaging.

• Type 5 Integrating Indicator (for steam sterilizers only), which mimics the abilities of a biological indicator at three different times and temperatures, without requiring incubation. A Type 5 integrator cannot replace a biological spore test. However, it can generate a distinct pass-or-fail result, providing the dental team with confidence to safely release the instruments in every sterilization cycle (not including implants). Type 5 integrators that are used daily, or with every load, may improve patient safety and reduce the cost and disruption of potential recalls when a biological indicator fails.

• Type 2 Bowie Dick air removal tests for Class B/Pre-vac sterilizers.

• Sterilization racks to assist with sterilization and the drying process. Sterilizer racks or coils allow pouches and cassettes to be placed vertically for efficient 360-circulation/exposure. Air removal, steam penetration and condensate drainage are enhanced by best practice and the vertical positioning of cassettes and pouches.

Distributor sales reps should remind their customers that the device manufacturer is most qualified to specify packaging requirements and sterilization methods, including the type of cycle, sterilization temperature and the exposure and drying time required based on instrument configuration.

Source: Crosstex International, a Cantel Medical company.

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Keefer. “Critical instruments, as well as semi-critical that are heat tolerant, must be heat sterilized after each use/patient.

“Cleaning before packaging is an important step in the sterilization process,” she continues. “Dental instruments vary in size, complexity, fragility and sensitivity to cleaning agents, which can impact the choice of cleaning method. Following the instrument manufacturer’s IFU for cleaning and sterilization of dental instruments and equipment is critical. Thorough rinsing of instruments and cassettes is critical after ultrasonic cleaning because any residual chemicals and enzymatic detergents on the instrument can impact the efficacy of sterilization and/or cause reactions to the surface of the instrument (spotting, pitting, staining).

Dental instruments must be rinsed thoroughly under running water to remove any loose debris, as well as the cleaning solution. The dental team should use an adequate volume of water and rinse instruments for a minimum of 30 seconds.

“Each instrument should be critically inspected after each cleaning for residual debris or any damage,” says Keefer. “Any bioburden remaining will interfere with the microbial kill and can compromise the sterilization process. Additionally, the dental team must check each instrument for proper function, and lubricate it as required by the instrument manufacturer.” According to one study, 91 percent of the instruments tested were found to be visually clean, she notes. When examined microscopically, however, 84 percent of the instruments had residual debris. “Sites that contained residual debris included articulations, hinged instruments and grooves on forceps,” she says. “The CDC indicates more research is needed to understand the clinical significance of these finds and how to ensure proper cleaning.”

If an instrument is in need of repair, she adds, it should be set aside or replaced.

Sales reps must understand how the sterilizer will be used.

For instance, how will dental instruments be packaged and loaded into the sterilizer? Does the practice use paper/plastic sterilization pouches and/ or instrument cassettes with sterilization wrap?

Sterilizers: Solutions that Work Increased awareness of infection control drives sterilization in dentistry.

As more dental professionals understand the importance of infection control in dental settings, sterilization protocols play an increasingly central role in their practices, according to Sarah Seaton, Manager Instrument Processing, Midmark Corp. “Although sterilization technology has evolved slowly, there have been definite improvements in monitoring and drying,” she says. “Increased awareness of the importance of infection control is driving more frequent monitoring of sterilization cycles to assure the effectiveness of the sterilization process. This increased use of monitoring devices, such as biological and chemical indicators, is exposing the need for monitors that respond more quickly to maintain efficient practice workflow. Manufacturers have responded to this need by developing biological indicators that can now provide results in as little as one hour for some applications.”

In addition, with the FDA recommendation that clinicians use recognized standard cycles, manufacturers are making adjustments to comply. “This standardization will help users in their efforts to comply with manufacturers’ instructions for use (IFU) for the instruments, packaging, monitoring devices and sterilizers used to effectively reprocess instruments for safe reuse,” says Seaton.

The right solution

Distributor sales reps can offer their customers the right sterilizer solutions when they are familiar with the dental practice capacity and workflow and understand what it takes to maximize its efficiency and effectiveness. Some points to consider: • Are the dental assistants constantly running to the instrument processing area to see if the tools they need are ready?

• Is there a backlog of instruments waiting to be sterilized?

• Does the practice require a larger capacity sterilizer?

• Is a high-speed, small-capacity sterilizer sufficient to meet the demands of the practice?

Additionally, sales reps must convey to the entire dental team the importance of adhering to current Centers for Disease Control and Prevention (CDC) guidelines for instrument processing. Indeed, a

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STERILIZATION sterilization system encompasses far more than a sterilizer alone, notes Seaton. “Dental professionals need to follow the guidelines outlined by the CDC, Occupational Safety and Health Administration (OSHA) and other state and local authorities,” she says. “It is a systematic process that must be well documented, and training must be delivered annually at a minimum. The CDC recommends following a five-step process: • R eceiving, cleaning and decontamination.

• P reparation and packaging.

• Sterilization.

•M onitoring/sterility assurance.

• Storage.

This process, when done properly, creates a flow from dirty to clean, which will help contain contamination and maximize the efficiency of the instrument cleaning and sterilization protocols at the dental practice.

Seaton recommends that dental practices purchase sterilizer racks and accessories designed to accommodate their instrument reprocessing workflow. “For instance, if they are pouching instruments, pouch racks will help orient the pouches in the best position for sterilization and drying,” she says. “Or, if they are standardizing on the use of cassettes, a cassette rack may be a better choice.” A dental practice may also need a printer or an electronic storage device to maintain a record of the sterilization cycle data. And, importantly, the practice must use water that meets quality standards to ensure the sterilizer operates reliably and efficiently.

should be in a separate, dedicated space. In fact, some offices use their sterilization areas as a marketing tool to show patients they value their health and safety.

“Steam sterilization is the most versatile, safest and cost-effective method of sterilization,” she continues. “However, some instruments can’t tolerate the high temperature associated with this process. Some sterilizers have a low temperature cycle (250°F) to address this need. Soaking instruments in liquid chemical germicides is another alternative for these devices. Occasionally, the moisture associated with steam can also be detrimental to some instruments, such as carbon steel, and cause corrosion. In those instances where higher quality instruments aren’t available or desirable, dry heat sterilizers might be another option.”

Sometimes, a small-capacity, high-speed sterilizer is the best option, notes Seaton. With a smaller, high-speed system,

“ Increased awareness of the importance of infection control is driving more frequent monitoring of sterilization cycles to assure the effectiveness of the sterilization process. This increased use of monitoring devices, such as biological and chemical indicators, is exposing the need for monitors that respond more quickly to maintain efficient practice workflow.”

– Sarah Seaton, Manager Instrument Processing, Midmark Corp

Guidelines and protocols In addition to selecting the right sterilizer solution, dental professionals must determine how many systems they require to meet the needs of the practice and where the instrument sterilization area will be located in their office. They must also be aware of – and follow – CDC guidelines regarding how frequently instruments should be sterilized and inspected. When sales reps educate their customers and provide direction, the practice will have an easier time creating an efficient, safe environment for staff and patients.

“In designing an office, experts recommend the sterilization area mirror the operatory space and should be easily accessed by the team to avoid delays and inefficiencies,” says Seaton.

“The area can be integrated into the design of the office, but it

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the practice may not require large quantities of high-priced and specialty instrumentation. When selecting sterilizers, it’s extremely important that the dental team consider what types of instruments will require sterilization, the quantity and quality of instruments available at the practice, and how frequently they are used, she adds.

It’s important that every dental practice clearly understand the CDC guidelines regarding safe and proper sterilization. “According to the CDC, dental instruments that penetrate soft tissue or bone, such as extraction forceps, scalpel blades, bone chisels, periodontal scalers and surgical burs, are classified as critical and should be sterilized after each use or discarded,”

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STERILIZATION The CDC recently posted the following statement regarding reprocessing dental handpieces, according to Seaton: “CDC guidelines for infection prevention and control state that, between patients, dental health care personnel (DHCP) should clean and heat-sterilize handpieces and other intraoral instruments that can be removed from the air and waterlines of dental units. This recommendation is based on studies that have shown that the internal components of air-driven dental handpieces (both low-speed and high-speed devices) can become contaminated with patient material during use, and this material can then be expelled into the mouth of other patients during subsequent uses.

For handpieces and other intraoral instruments that can be removed from the air and waterlines of dental units, CDC continues to recommend that DHCP follow CDC guidelines to clean and heat sterilize.”

The CDC recommends cleaning and sterilizing instruments as soon as possible after use, notes Seaton. In addition, dental professionals should always follow the IFU for each instrument to achieve best results. “If cleaning can’t be performed immediately after use, the instruments should be placed in a puncture-resistant container with a detergent, a disinfectant/ detergent, or an enzymatic cleaner to prevent the drying of contaminants [and to ensure] easier cleaning later on.”

– Sarah Seaton, Manager Instrument Processing, Midmark Corp In addition, instruments should be inspected prior to sterilization to ensure they are clean; that they aren’t damaged, rusted or pitted; and that they says Seaton. Patient-care items are categorized based on the function properly and are dry before wrapping and sterilizing, Seaton potential risk for transmission of infection associated with their points out. “Instruments that are not clean cannot be properly sterintended use: ilized,” she says. “After sterilization, and prior to use, instruments •C ritical items are those that penetrate soft tissue or should be visually and operationally inspected to ensure there is bone and have the highest risk of transmitting infections. no evidence of a breach in the cleaning and sterilization process. If These items should always be heat sterilized. the office is not following the recommended settings for steriliza• Semi-critical items include those that touch mucous tion of their instruments, they could potentially damage them. membranes; they have a lower risk of transmission “Dentists continue to look for reliability in sterilizer brands than critical items. Most semi-critical items can – and they trust,” says Seaton. “Sterilization is a critical function of should – be heat sterilized. If they cannot tolerate their practice. If their instruments are not sterile and ready for heat sterilization, they should be processed using a use, they cannot serve their patients’ needs.” high-level disinfectant.

“ Steam sterilization is the most versatile, safest and cost-effective method of sterilization.

However, some instruments can’t tolerate the high temperature associated with this process.

Some sterilizers have a low temperature cycle (250°F) to address this need. Soaking instruments in liquid chemical germicides is another alternative for these devices.”

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Steri-centers A carefully planned sterilization center makes it easier for the dental practice to adhere to safe sterilization protocols.

Most dentists appreciate the importance of sterilizing their instru-

ments to prevent the spread of infection. Still, they may not realize that a wellplanned sterilization center – or steri-center – can be key to an efficient practice.

“Steri-centers are often overlooked,” says Stacey Graf, manager and U.S. marketing coordinator, SciCan Inc. “But, if instruments cannot efficiently flow into and out of the sterilization area, the rest of the practice will suffer.

“Sterilization centers should be designed with compliance in mind,” she points out. “Instrument processing should meet or exceed all federal OSHA standards, the 2003 and 2016 Centers for Disease Control and Prevention (CDC) dental guidelines and summary, and all state dental laws.” The size of the dental practice should determine how many sterilizers it requires, she adds. Not having enough sterilizers can lead to a bottleneck in instrument reprocessing. At the very least, a smaller practice should have a backup sterilizer in case one fails.

“Steri-centers are often overlooked. But, if instruments cannot efficiently flow into and out of the sterilization area, the rest of the practice will suffer.”

– Stacey Graf, manager and U.S. marketing coordinator, SciCan Inc

“Sterilizers should be inspected per the manufacturer’s instructions for use,” says Graf. “A biological spore test should be run at least weekly, per CDC guidelines, and a test strip should be placed in every load.

“It’s not only important to prevent the dental staff’s exposure to sharps, but also to biologically contaminated fluids and aerosols generated by open-lid ultrasonic cleaning and cold sterile solutions,” she continues. “In addition, there should be systems in place to prevent the contamination of instruments once they are processed and to ensure they are safe for use on patients.” Regardless of the size of the practice or the number of patients served, dental instruments should be processed in the safest, most efficient way possible to reduce the risk of staff injury and the costs associated with exposure incidents, she adds.

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SPONSORED: STERISIL

Municipal Tap Water: Use with Caution

BY JEROD MENDOLIA

Hey you, yeah you, filling that dental bottle at the faucet. How clean do you

annual proportion of reported deficiencies that were associated with the inadequate or interrupted treatment of water by public water systems”3.

For dental professionals in large healthcare facilities, it is certainly worth considering speaking with building managers about the plans for water treatment within the building. Systems of water quality monitoring and intermittent testing should be in place where the consequences could be serious.

Variations in tap water quality are virtually infinite and therefore, tap water should not be relied upon for consistent disinfection results. The presence of municipal additives such as chlorine and fluoride complicates things further if you are trying to manage the chemistry to get the best results. If you don’t, you have a concoction of different chemicals and additives mixing in the waterline. The byproduct of these unwanted mixtures is called “precipitates,” and their presence indicates the diminished effectiveness of whatever you have in the water to control microbes. So what is the solution?

think that water is? Have you checked to see if there were any boil water alerts lately? Do you have any filtration or purification in place for that supply? Are you assuming that water is clean enough for use in the dental chair, or do you know for sure? I hope you have some sound disinfection protocols in place. If you knew what could be in that water, you might think twice.

When you look deeper into past issues related to pathogens and tap water, the revelations might have you thinking twice about filling that dental bottle at the tap. Independent bottle reservoirs were intended to give practitioners the flexibility to avoid tap water and the potential problems it presents. So why not take advantage of it? Why fill with water from the tap? Doing so would imply that you are either testing routinely or just assuming it is of good quality.

With so much waterline infection control information available, most clinicians know the hard facts that municipal tap water could be contributing to their bacteria problems. Public water works delivering your municipal tap water are prone to contamination and breaches in their own water quality standards.

Common events such as a water main break, leak, or drop in pressure, present an opportunity for pathogens to gain access to the public works.

As of 1971, the Centers for Disease Control and Prevention (CDC), U.S. Environmental Protection Agency (EPA), and the Council of State and Territorial Epidemiologists (CSTE) have been tracking and quantifying these waterborne disease outbreaks in the United States. The most interesting insight from the data they provide is that over the 36-year period from 1971 to 2007, “a trend analysis found a statistically significant decrease in the

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The nature of distillation requires that you heat the water to remove impurities. This hot distillate is now primed for recolonization by bacteria.

Max out your safety margin To attain maximum chemical control, “distilled quality” water works

By the numbers According to a 2012 report, failures in public treatment have been the cause of several bacterial and viral outbreaks of Salmonella, Campylobacter, Shigella, E. coli O157:H7, Cryptosporidium, Giardia and Norovirus1,2.

Conversely, the amount of outbreaks related to flaws in premise plumbing has increased in that time3. Privately managed water treatment, or premises treatment, are technically outside the jurisdiction of a water utility.

The liability falls to building managers to implement a strategy for maintaining waterlines “after the meter.”

best. We say distilled quality because water from a distiller is not always optimal for dental water. The nature of distillation requires that you heat the water to remove impurities. This hot distillate is now primed for recolonization by bacteria. Without immediate waterline treatment, this water will most assuredly be contaminated by the time it reaches the dental bottle. Distillers themselves are often the source of contamination for many offices as once the storage tank is contaminated, the water is then distributed along with the bacteria to the entire office.

The best strategy is a point-of-use purification system using deionization to remove all the impurities without heating the water. Ultraviolet disinfection can then be employed to drastically

Less is more If a dentist intends to use their municipal water for dental water, and yes there is a difference, it would be advisable to have some level of water quality analysis before selecting a disinfection product.

lower the existing bacterial load with proven effectiveness5. The water would then receive a low concentration of a residual disinfectant. The final product is water that is neutral in pH, contains less than 10ppm total dissolved solids, disinfected, and contains some variety of residual disinfectant.

No excuses Attaining and utilizing distilled quality water is easier and more affordable than ever. It’s use protects the dental practice from potential contamination within the public treatment works of which there are numerous cases which have tap water as a contributing factor. Steer clear of distillers, as they are often contaminated and are more work to maintain than their deionization counterparts. Distilled water is an essential building block of a successful disinfection protocol.

Case in point In 2015, reports began to circulate that a cluster of Mycobacterium abscessus infections had been identified in Atlanta, GA after 9 pediatric patients were hospitalized in the same facility. The CDC reported that the Georgia Department of Public Health (GDPH) initiated an investigation which revealed all the patients (between the ages of 3-11) had previously underwent a pulpotomy procedure at the same dental clinic. Upon visiting the clinic to evaluate their infection control policies, GDPH staff indicated the practice used tap water for irrigation during the pulpotomies.

The report also indicated the practice lacked any level of monitoring or disinfection efforts as directed by the chair manufacturer. The report concluded that all 7 operatories had bacterial counts above the 500 colony forming unit (CFU) drinking water standard and M. abscessus was identified in all samples4.

References

1. I ngerson-Mahar, M.; Reid, A. Microbes in Pipes: The Microbiology of the Water Distribution System A Report on an American Academy of Microbiology Colloquium; ASM Academy: Boulder, CO, USA, 2012; p. 26.

2. R amìrez-Castillo, Flor, et al. “Waterborne Pathogens: Detection Methods and Challenges.” Pathogens, vol. 4, no. 2, 2015, pp. 307–334., doi:10.3390/ pathogens4020307.

3. C raun, Gunther F., et al. “Welcome to CAB Direct.” CLINICAL MICROBIOLOGY REVIEWS, vol. 23, no. 3, July 2010, pp. 507–528., www.cabdirect.org/cabdirect/abstract/20103246391.

4. Peralta, Gianna, et al. “Morbidity and Mortality Weekly Report (MMWR).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 25 Aug. 2017, www.cdc.gov/mmwr/volumes/65/wr/mm6513a5.htm.OSAP - Dental Unit Waterlines 5. U V Dose Required to Achieve Incremental Log Inactivation of Bacteria, Protozoa and Viruses Gabriel Chevrefils, B.Ing,2 and Eric Caron, B.Sc.2

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INFECTION CONTROL

Reprocessing Dental Handpieces Compliance with CDC guidelines for reprocessing is vital to the safety of the dental staff and patients.

There seems to be a lot of buzz about dental handpieces these days. For whatever

reason, the question of reprocessing these devices for patient use is once again a popular conversation in dental practices. Dental handpieces are medical devices accompanied by instructions for use (IFU). As discussed in a previous article, IFU are provided for medical devices and products in accordance with federal Food and Drug Administration (FDA) standards and provide information on cleaning, disinfection and sterilization of patient care items.1 In any dental setting, IFUs must be strictly followed to ensure patient safety, as well as peak performance of the devices. Whether the organization is a group practice or a solo practice, there must be a sufficient number of instruments to serve the patient schedules in order to avoid shortcuts in reprocessing.

Categories of patient care items The Centers for Disease Control and Prevention sorts patient care items into three categories (referred to as the Spaulding classification), based on the potential risk for infection associated with their intended use: critical, semicritical or noncritical.2,3

Infection-control categories of patient-care instruments Category Critical

Definition

Dental instruments or item

Penetrates soft tissue, contacts bone, enters into or Surgical instruments, periodontal scalers, scalpel contacts the blood-stream or other normally sterile tissue. blades, surgical dental burs

Semicritical Contacts mucous membranes or nonintact skin; will not penetrate soft tissue, contact bone, enter into or contact the bloodstream or other normally sterile tissue.

Dental mouth mirror, amalgam condenser reusable dental impression trays, dental handpieces*

Noncritical

Radiograph head/cone, blood pressure cuff, facebow, pulse oximeter

Contacts intact skin.

* Although dental handpieces are considered a semicritical item, they should always be heat-sterilized between uses and not high-level disinfected (246). See Dental Handpieces and Other Devices Attached to Air or Waterlines for detailed information.

Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings – 2003. MMWR 2003;52(No. RR-17); 20.

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INFECTION CONTROL At the ends of the spectrum are the critical and noncritical patient care items. According to the CDC, all critical items should be heat sterilized between patient use, as they have the greatest risk of transmitting infection. Noncritical items, which pose the least risk of disease transmission, should be cleaned and disinfected with an EPA-registered hospital disinfectant.2,4 In the middle of the spectrum are semicritical items. These items come in contact with mucous – or non-intact – membranes, but they do not penetrate soft tissue, contact bone, the bloodstream or other normally sterile tissues.2 Dental handpieces are considered semicritical items. The CDC states, “dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles,

endodontic, and surgical handpieces, as well as all handpiece motors and attachments, such as reusable prophylaxis angles, nose cones, and contra-angles.”8 There is continuous debate about CDC guidelines and recommendations: Do practices need to follow them, since they are just a guideline? The short answer is, yes. All practice settings should follow these guidelines. Larger group practices generally have the infrastructure to carry out best practices and, as such, can serve as a model of compliance. Unlike OSHA, the CDC is not a governmental regulatory body. Nevertheless, it provides scientific evidence-based best practices for patient safety and reducing disease transmission, and the American Dental Association endorses all CDC guidelines for infection prevention in dental healthcare settings.6

CDC statement

should always be heat sterilized between patients and not high-level or surface disinfected. Although these devices are considered semicritical, studies have shown that their internal surfaces can become contaminated with patient materials during use. If these devices are not properly cleaned and heat sterilized, the next patient may be exposed to potentially infectious materials.”4,5,6 In other words, there are no shortcuts to patient safety around handpieces, including low-speed motors use primarily for hygiene appointments. Eleven states require heat sterilization of dental handpieces: California, Florida, Indiana, Kansas, Missouri, New Mexico, Ohio, Oregon, South Carolina, Virginia, and Washington.7 And, the CDC guidelines fully apply in the remaining 39 states. Additional guidance from the CDC states, “handpieces and other intraoral devices that can be removed from the air and waterlines of dental units should be cleaned and heat-sterilized between patients. Follow the manufacturer’s instructions for cleaning, lubricating, and sterilizing these devices. These devices include high-speed, low-speed, electric,

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On April 11, 2018, the CDC released the following update regarding reprocessing dental handpieces: “CDC recognizes that the dental community requires clear, consistent guidelines on the best way to reprocess dental handpiece devices between patient encounters. CDC guidelines for infection prevention and control state that, between patients, dental health care personnel (DHCP) should clean and heatsterilize handpieces and other intraoral instruments that can be removed from the air and waterlines of dental units. This recommendation is based on studies that have shown that the internal components of air-driven dental handpieces (both low-speed and high-speed devices) can become contaminated with patient material during use, and this material can then be expelled into the mouth of other patients during subsequent uses. For handpieces and other intraoral instruments that can be removed from the air and waterlines of dental units, CDC continues to recommend that DHCP follow CDC guidelines to clean and heat sterilize.”9 The CDC goes on to say, “some handpieces are independent of air and waterlines (e.g., cordless devices). For these devices, CDC recommends that DHCP follow current FDA regulations, use FDA-cleared devices and follow the validated manufacturer’s IFU for reprocessing (cleaning, lubricating, and/or sterilizing) these devices.”9 The marketplace offers a variety of cordless, slow-speed motors with sterilizable outer sheaths that run on batteries and are fully compliant with CDC sterilization guidelines. Dental practices should evaluate their supply of handpieces and perform a cost analysis to determine the model type and amount of equipment they need.

The guidance on reprocessing handpieces for all dental practice settings is clear. In order to be compliant with CDC recommendations, more than one handpiece is needed to ensure enough time for them to be heat sterilized between each patient.

It should be noted that in 2015, the FDA released updated guidance for reprocessing medical devices in healthcare settings. This guidance provides manufacturers of reusable medical devices with recommendations for writing and scientifically validating reprocessing instructions. Reusable devices that received FDA clearance before 2015 might not have reprocessing instructions that meet the requirements of the 2015 guidance.9,10 According to FDA, “reprocessing instructions for some older, legally-marketed, reusable devices may not be consistent with state-of-the-art science and therefore may not ensure that device is clean, disinfected, or sterile.” It is incumbent on the device manufacturer to provide sufficient instructions on how to prepare devices for use on the next patient.9,10 Both the CDC and FDA state that if a dental handpiece cannot be heat sterilized and does not have FDA clearance with validated instructions for reprocessing, DHCP should not use that device.2,4,10 The updated guidance from the CDC provides a 3-point summary: 1. Clean and heat sterilize handpieces and other intraoral instruments that can be removed from the air lines and waterlines of dental units.

2. For handpieces that do not attach to air lines and waterlines, use FDA-cleared devices and follow the validated manufacturer’s instructions for reprocessing these devices.

3. If a dental handpiece cannot be heat sterilized and does not have FDA clearance with validated instructions for reprocessing, do not use that device.9

The guidance on reprocessing handpieces for all dental practice settings is clear. In order to be compliant with CDC recommendations, more than one handpiece is needed to ensure enough time for them to be heat sterilized between each patient. Saying it is too expensive to buy more than one handpiece is not an excuse the CDC is likely to entertain. A dental practice is a business, and to run a business there are costs. Purchasing equipment, such as handpieces, should be considered the cost of doing business.11 The size of the dental practice setting and its ability to comply to CDC guidelines for reprocessing and recommendations are vital to patient and staff safety.

Editor’s note: 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.

References

1. S chrubbe K. Instructions for use. Efficiency in Group Practice. Available at http://www.dentalgrouppractice.com/instructions-for-use.html. Accessed April 24, 2018.

2. C enters for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings – 2003. MMWR 2003;52(No. RR-17); 20.

3. M iller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team. 5th ed. St. Louis: Mosby Elsevier; 2013; 122.

4. C enters for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health, March 2016.

5. C hin J.R., Miller C.H., Palenik, C.J. (2006). Internal contamination of air-driven low-speed handpieces and attached prophy angles. J Am Dent Assoc. 137(9):1275-80. Available at http://www.ncbi.nlm.nih.gov/pubmed/16946433. Accessed May 10, 2018.

6. American Dental Association. Oral health topics; infection control. Available at https://www.ada.org/en/member-center/oral-health-topics/infection-control-resources. Accessed May 10, 2018.

7. The Dental Student Network list of state licensing agencies. Available at http://www.studentdoctor.net/dental/state_boards.html. Accessed April 24, 2018.

8. C enters for Disease Control and Prevention. Dental Handpieces and Other Devices Attached to Air and Waterlines. Available at https://www.cdc.gov/oralhealth/infectioncontrol/ questions/dental-handpieces.html. Accessed May 10, 2018.

9. C enters for Disease Control and Prevention. Statement on Reprocessing Dental Handpieces, April 11, 2018. Available at https://www.cdc.gov/oralhealth/infectioncontrol/statement-on-reprocessing-dental-handpieces.htm. Accessed May 10, 2018.

10. U S Department of Health and Human Services. Public Health Service Food and Drug Administration. Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling Guidance for Industry and Food and Drug Administration Staff. March 17, 2015. https://www.fda.gov/downloads/medicaldevices/deviceregulationandguidance/ guidancedocuments/ucm253010.pdf. Accessed May 10, 2018.

11. Vavrosky K. 5 infection control mistakes you may be making and not even realize. Dental Products Report, July 11, 2016. Available at http://www.dentalproductsreport.com/ hygiene/article/5-infection-control-mistakes-you-may-be-making-and-not-even-realize?page=0,1. Accessed May 10, 2018.

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SALES FOCUS: CURING LIGHTS

The Right Cure Whether your dental customers value efficiency, ease of use or both, today’s curing lights are designed to address their needs.

That said, not all curing lights are created equally. Lights vary with regard to depth of cure, uniformity of beam, curing time, amount of heat generated and curing spectrum.

The lightweight, cordless VALIANT™ Multispectral curing light by Vista Dental Products is reportedly one of three multispectral lights on the market with the capacity to cure all types of material. The VALIANT™ features a built-in transilluminator and induction charging. The light can be easily operated using a single-button. Four uniformly arranged LEDs operate through three curing modes (standard, ramp and boost); boost mode provides a three-second cure.

VALIANT is a multispectral curing light, which has been specifically tuned to all commonly used photoinitiators, allowing the device to efficiently cure all dental materials on the market.

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How has the technology improved in recent years?

VALIANT is a multispectral curing light, which has been specifically tuned to all commonly used photo-initiators, allowing the device to efficiently cure all dental materials on the market. The unit’s robust, lightweight aluminum body is said to provide excellent heat management.

Precision optics ensure uniform polymerization and deep depth of cure. A uniform beam profile eliminates the potential for hot and cool spots or uneven curing. A 6.8mm depth of cure on standard mode allows the clinician to confidently place larger incremental layers, saving time.

What is the lifetime of the product?

Your customers can depend on the VALIANT curing light to last well over three years. It comes with a three-year warranty – reportedly one of the longest warranties available for curing lights. Two rechargeable batteries are included, providing over 250 curing cycles on a single charge.

THE POWER TO CONFIDENTLY CURE. • • • •

6.8mm depth of cure on standard mode Precision optics offer an extremely uniform beam One of the few lights capable of curing ALL materials 300 ten second cures on a single charge AND includes 2 batteries

LED BEAM PROFILE

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When should the curing light be serviced or repaired?

Curing lights should be checked regularly with a radiometer to ensure they are running at optimal levels. Vista dental warranties the optics of their light for three years.

What can dental customers expect to pay?

Dentists may purchase the VALIANT curing light for $995 USD. In addition, Vista™ is running a year-long promotion: Dentists receive $400 in Vista merchandise credit when they turn in their old multispectral light and purchase a VALIANT.

What probing questions should distributor sales reps ask to initiate a discussion with their customers?

• “Doctor, what curing lights do your currently use at your practice?”

• “When was the last time your light was checked with a radiometer?”

VALIANT ®

Curing lights should be checked regularly with a radiometer to ensure they are running at optimal levels.

OTHER LEADING MULTISPECTRAL

• “Are you confident your light cures deep and uniformly?”

• “Would you like to be able to cure deeper restorations with confidence?”

• “How do you feel about the weight of your current curing light?”

• “Do you use a multispectral light?

What objections might dentists have to trying a new curing light?

How can sales reps respond?

• “Lower-priced curing lights sometimes reflect a lack of quality.”

• “The VALIANT offers great quality at an affordable cost, and its three-year warranty ensures extended care. Vista stands behind its products.”

Editor’s note: Sponsored by Vista™

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29

SALES FOCUS: CURING LIGHTS

Reliable Results The S.P.E.C. 3

curing light by Coltene makes curing fast, easy and reliable for your dental customers. The unit features three modes: standard (1600mW/cm2), 3k mode (3000mW/cm2) and ortho-mode (3000mW/cm2) for bracket curing. The S.P.E.C. 3 emits blue light (430-460nm) with LEDs for the photo activation of the initiator camphorquinone and the efficient polymerization of dental materials.

What can dental customers expect to pay?

How has the technology improved in recent years?

As LED lights have become state-of-theart, fewer and fewer dentists today rely on halogen lights. Newer LED lights are more efficient, generate less heat and produce an even beam profile. The LED spectrum can change from single wave (430-490nm) to a multi-wave (385490nm), and in the process activate other initiators, as well.

What is the lifetime of the product?

Because many clinicians are accustomed to curing all materials for 10 or 20 seconds, they often miss out on the S.P.E.C. 3’s one-second cure option, using a 3K mode.

The S.P.E.C. 3 has a lifetime of approximately five years, depending on usage.

(The battery may have to be changed sooner.). Replacing the light curing unit (LCU) on the charger base when not in use helps prevent a complete discharge.

Other maintenance tips include avoiding dropping or knocking the LCU, using barrier sleeves and carefully cleaning the unit. (Users should avoid using too much cleaning solution and inadvertently drowning the LCU.)

When should the curing light be serviced or repaired?

If the S.P.E.C. 3 does not function properly, according to the user manual, it may require servicing or repair. Dental users should pay attention to several warning signs: • B uttons do not work.

• There is no light output, even after charging, replacing the battery and cleaning the light guide.

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• The light does not polymerize material well, even after using a test block.

• The light flickers or is unstable.

• The housing is damaged.

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Premium LCUs cost between $900$1,500 USD. Less expensive units tend to include fewer options, or modes. They may have an inhomogeneous beam profile and be constructed of low-quality parts (e.g. housing). In addition, dentists run the risk that the unit will yield a massive drop in light output after some uses or stop working sooner than expected.

What probing questions should distributor sales reps ask to initiate a discussion with their customers?

• “Doctor, have you thought about updating your curing light(s) to increase your productivity and save time?”

• “Have you tested the output of your curing light recently?

This can be easily done using a Coltene composite test block or radiometer.”

What objections might dentists have to trying a new curing light? How can sales reps respond?

Because many clinicians are accustomed to curing all materials for 10 or 20 seconds, they often miss out on the S.P.E.C. 3’s one-second cure option, using a 3K mode. Sales reps should educate their customers on LCU’s output. Dentists may feel more comfortable transitioning to a 5- or 10-second cure option, using the standard mode.

Editor’s note: Sponsored by Coltene

SALES FOCUS: CURING LIGHTS

The Ideal Cure As curing technology has become increasingly sophisticated, curing lights have become more and more diverse, leading dentists to question which light solution and bulk fill composite best meets the needs of their practice.

BY LAURA THILL

Curing lights today are an integral part of modern dentistry, notes Sha-

shikant Singhal, BDS, MS, director of professional services, Ivoclar Vivadent, Inc. “Nowadays, curing lights are used not only to polymerize dental composites, but also to cure dental adhesives; resin cements in various clinical situations, like curing through ceramic restorations; post and cores; and deep restorative cavities,” he says. “Therefore, to provide an ideal restoration with long-term clinical success, it is critical for a clinician to select a curing light that meets all the requirements.”

Curing light technology features quartz-tungsten halogen, plasma arc, argon laser and most contemporary LED curing lights, he adds. But, that begs the question: How can dental providers determine the ideal curing light solution for the needs of their practice?

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The science behind the cure The rapid changes in light curing technology in recent years – and the impact this has had on the chemistry of lightcured resin-based materials – makes it more important than ever for dentists to fully understand the curing process, as well as challenges. “Clinicians must understand the chemistry of the composite, their curing lights and the polymerization technique, as inadequate

power intensity of 1000 mW/cm2. “The light units with lower polymerized composite restorations tend to show high wear, power intensity can result in compromised polymerization of a chipping, catastrophic fracture and compromised esthetic by resin composite,” he points out. staining,” says Singhal.

Finally, it is also critical to have uniform distribution of light For starters, light cured resin-based materials consist of – or beam homogeneity – at the end of the curing light probe a number of ingredients, including resin matrix; filler particles to ensure the composite material is uniformly and adequately coupled with matrix, using coupling agents; and photo-initiators, polymerized, he says. “A non-uniform distribution of light enaccording to Singhal. “The photo-initiators absorb light energy ergy results in localized hot spots of adequate energy, resultof specific wavelengths from curing light units,” he explains. ing in inadequate polymerization of the “The energy absorbed excites the molremaining exposed composite surface. ecules and enables the formation of free These lights tend to be more economical, radicals; this, in turn, initiates polymerbut they have limitations, such as a nonization.” For years, clinicians relied on homogenous beam profile or a narrow the photo-initiator, Camphorquinone, he spectrum, which can compromise the points out. However, Camphorquinone clinical outcome.” has a yellowish color, prompting the use Ivoclar’s Bluephase® Style curing of lighter colored initiators, such as Lucirin TPO and phenyl-propanedione (PPD). light from Ivoclar Vivadent meets SingRecently, Ivoclar Vivadent patented a new hal’s standards for wavelength spectrum, Shashikant Singhal photo-initiator, Ivocerin, designed for use power intensity and a homogenous beam in bulk fill technology and color stable profile. “Bluephase Style curing lights are resin cements. equipped with advance polywave light When purchasing a new curing light, emitting diode technology, enabling them Singhal looks for light units that offer a to achieve an optimal broad spectrum broad wavelength spectrum, high power wavelength range from 385 - 515 nm, intensity and a homogenous beam prowith high power intensity of 1,200 mW/ file – attributes that ensure the curing cm2,” he says. “Polywave technology light unit will adequately polymerize all serves as a benchmark for many cliniresin-based material, he notes. “Photocians, as it enables them to cure all dental initiators absorb light energy of a sperestorative materials with different photocific wavelength spectrum to facilitate initiators systems (e.g. Camphorquinone, the polymerization,” he says. “Most – but Lucirin TPO, phenylpropanedione (PPD), not all – contemporary LED curing lights Ivocerin etc.). Additionally, Bluephase have a narrow wavelength spectrum of Style curing lights are equipped with a 430 - 480 nm. The absorption spectrum parallel light guide, which helps reduce of Camphorquinone (CQ) is between 390 light-intensity loss when the light guide – 510 nm, and Ivocerin is between 370needs to be held at distances from the 460 nm.” By comparison, Lucirin TPO material to be irradiated.” The Bluephase – Shashikant Singhal, BDS, MS, and PPD absorb light in the range of less Style’s light guide, in combination with director of professional services, than 430 nm, and the materials may not the unit’s ergonomic pen design, ensures Ivoclar Vivadent, Inc. be cured properly using a narrow speceasy access to the entire mouth, he adds. trum LED curing light, he adds.

It’s also important to consider the amount of energy reMyths and challenges quired to adequately polymerize the material, says Singhal. “This Few non-surgical restorative procedures today do not require is calculated by the power intensity of a curing light exposed the light polymerization of dental materials. “While there has over a period,” he explains. To ensure adequate polymerization, been much attention to the details of diagnosis, clinical procemost manufacturers recommend between 10 and 20 seconds dures and the development of improved adhesives and resins, of light polymerization for a resin composite, with a curing light light polymerization is often taken for granted,” says Singhal.

“Curing lights are used not only to polymerize dental composites, but also to cure dental adhesives; resin cements in various clinical situations, like curing through ceramic restorations; post and cores; and deep restorative cavities.”

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SALES FOCUS: CURING LIGHTS Some clinicians may not fully understand the curing process, he notes. “Not all curing lights are the same, and not all hard materials are completely polymerized, and it’s important that dentists be aware of this,” he says.

Indeed, there is much variance from one curing light to another, Singhal points out. Higher end curing light units, designed with a higher quality LED curing light, tend to provide consistent power output over longer periods of time, he notes. It’s equally important for dental offices to measure power output of their curing lights regularly. “Dental manufacturers invest in a highquality radiometer devices like an integrating sphere, which can measure power output of a curing light with accuracy of ± 5 percent, however these devices are expensive,” he adds. “Other less expensive chairside radiometers are also available.”

Again, dentists get what they pay for, and the less expensive, conventional hand held radiometers fail to provide accurate light intensity measurements, in his opinion. “Most handheld radiometers are only capable of measuring power output over a small area of the probe, resulting in an inaccurate or false reading,” he says. “In contrast, Ivoclar Vivadent’s Bluephase® meter II features a surface sensor, permitting the meter to measure power output over the radiating surface of the curing light probe with an accuracy of ± 10 percent.”

Investing in higher end equipment and materials not only helps ensure optimal results, it often saves dentists – and patients – time, Singhal notes. For instance, using traditional resinbased filling material requires a longer time to polymerize increments of composites, while restoring deep cavities, he says.

“Factors such as air bubbles, compromised adaptation of layers,

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contamination and heat generation from multiple polymerization cycles during the restorative procedure can further compromise the clinical outcome,” he explains. “Other factors, like composite shades and translucencies, can also affect the light polymerization reaction. Lab studies have shown that darker, opaque dentin shades require higher light energy for polymerization compared to lighter, more translucent enamel shades. Conventional initiator systems alone are unable to cure increments exceeding 1.5 2 mm. So, it’s critical that clinicians consider all variables during polymerization of these materials.”

Bulk fill composites Dentistry is quickly changing, notes Singhal, and with that comes the availability of increasingly efficient products – including bulk fill composites.

“These materials have higher depth of cure compared to conventional composites and allow clinicians to restore cavities in thick increments of 4-5 mm, decreasing chairside time without compromising clinical outcome.”

Dental manufacturers can achieve an increased depth of cure by increasing either the concentration of photoinitiators, curing time or translucency of the material, he says. “Increasing the concentration of photo-initiators and polymerization time will enhance reactivity of the material to light energy, whereas increased translucency allows deeper – Shashikant Singhal light penetration to achieve a higher depth of cure,” he explains. That said, increasing photo-initiator concentrations can decrease working time, while an increased polymerization time means greater heat generation from the curing light unit and a longer chairside time, and increased translucency can compromise the esthetics of the restoration.

Unlike conventional approaches, which employ a composite layering technique, Ivoclar Vivadent’s Tetric® EvoCeram Bulk Fill composite – a light cured composite indicated for direct restorations in posterior teeth and for class V restorations –

“ While there has been much attention to the details of diagnosis, clinical procedures and the development of improved adhesives and resins, light polymerization is often taken for granted.”

has a sculptable viscosity and is formulated to be light polymerized in bulk increments of up to 4 mm, notes Singhal.

“The time required to adequately polymerize this material from a light curing unit with an intensity greater than 1000 mW/cm2 is only 10 seconds,” he says. “Tetric EvoCeram Bulk Fill includes a patented light initiator/polymerization booster, Ivocerin, for a high depth of cure. It combines advanced compositefiller technology to achieve the desired mechanical properties and high surface finish; a pre-polymer shrinkage stress reliever to minimize polymerization shrinkage stress; and a light sensitivity filter for adequate working time.

“Ivocerin is truly an innovation in photo-polymerization technology,” he continues. “Traditional photo-initiator systems, such as Camphorquinone, have limitations, such as low quantum efficiency (low sensitivity to light). In addition, the use of amine-based co-initiators with Camphorquinone may cause discoloration of composite material due to the oxidation of the remaining amine component. To overcome these challenges, and to innovate an ideal photo-initiator technology for contemporary bulk fill materials, Ivoclar Vivadent collaborated with Professor R. Liska of the Vienna University of Technology to develop and patent the germanium-based photoinitiator, Ivocerin. Unlike conventional photo-initiators, Ivocerin is approximately ten times more reactive to the curing light, thereby requiring less light energy. The absorption spectrum of Ivocerin ranges from 370 nm – 460 nm, so light can be activated using commercially available curing light units. And, Ivocerin’s amine free chemistry ensures that composite materials are highly color stable.”

For Ivoclar Vivadent Inc., innovation comes down to the ability to perfect strategies, products and services, Singhal points out. “We strive to anticipate our customers’ needs, and we continually challenge our research and development team to find better, more effective and efficient solutions to meet clinicians’ requirements.

“ Clinicians must understand the chemistry of the composite, their curing lights and the polymerization technique, as inadequate polymerized composite restorations tend to show high wear, chipping, catastrophic fracture and compromised esthetic by staining.”

– Shashikant Singhal

“Ivoclar’s research and development team includes chemists, researchers and well-trained dental professionals, who understand what dentists truly need to run a successful practice,” Singhal says. “Once a product is developed, our team creates educational content, such as scientific literature and animated and clinical tip videos, which are available on the Ivoclar Vivadent North American website.” These resources – as well as online training sessions – are available to dentists, as well as their staff and their distributor sales reps, he adds. “Our longtime customer service support, which includes experienced clinicians, registered dental hygienists/assistants and trained customer service representatives, is always available. We mean it when we say, ‘Customer satisfaction is guaranteed!’”

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WINDSHIELD TIME

Chances are you spend a lot of time in your car. Here’s some automotive-related news that might help you appreciate your home-away-from-home a little more.

Automotive-related news Atomium Sky The connection of the real and virtual world as well as the relationship of earth and space is captured in the BASF Coating’s key color, Atomium Sky, predicted to influence 2022 vehicle models in North America. This is the second consecutive year that BASF selected a blue as its key color, demonstrating its growing prominence in this region. “Atomium Sky is a deeply saturated blue with a medium coarseness that transitions to a BASF Coating’s key color, Atomium Sky

softer, semi-opaque hue, exuding playfulness while demonstrating futuristic and forward-thinking,” says the company. Atomium Sky is just one of 65 colors for automotive surfaces featured in BASF’s 2018-19 Automotive Color Trends. Others include Metal’s Mettle, Centripetal Blue and Kleur.

On-demand deliveries by drone Boeing announced its investment in Matternet, a Menlo Park, California-based startup pioneering on-demand unmanned aerial vehicle (UAV) delivery operations in urban environments. Matternet’s logistics platform – combined with Boeing’s expertise in complex logistics, integration and manufacturing capabilities – will further enable reliable, efficient cargo air transportation, according to the companies. Matternet received authorization to launch UAV operations over densely populated areas in Switzerland in 2017.

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Leveraging its Matternet Station, M2 drone and Cloud platform, the company achieved safe flights over densely populated areas and partnered with Swiss Post for on-demand deliveries of medical samples to hospitals in Switzerland.

Replace your own car key No more trips to the dealer to replace a lost key. The product development division of Louisville, Kentucky-based Car Keys Express released a consumer-programmable, universal aftermarket key for Ford, Lincoln, and Mercury vehicles. The key, with integrated remote, is said to have the same functionality as standard OEM versions and was scheduled to be available for purchase in August. This key is the second device to be released in the company’s new product line, Simple™ Key. Each key in the product line allows retailers to offer consumers a simple, “do-it-yourself” solution for replacing modern car keys. These products include a universal key and, if required, an EZ Installer™, allowing customers to pair the key to their vehicle. Once cut, consumers follow instructions to pair the key in just a few minutes.

Scoot to your next call Driving in a busy metro area? Go to your next call in a VehiGo – a three-wheel, standup electric scooter said to guarantee riders a safe and natural trip. Users can stand on the feet plate without holding the handlebar and keep natural balance. Lean left or lean right – it won’t tumble. With 360-degree limitless steering, users can operate forward and backward without stepping off the scooter. The 130MP wide lens camera will record the riding and automatically upload to cellphone, which allows the user to share the riding story to friends, family – or sales manager. And when the ride is done, users can fold and drag the VehiGo like luggage on the street, get in the elevator, subway or hospital hall, or put it next to the working desk. The manufacturer, Alllu, has started a Kickstarter campaign.

6 P R O P H Y PA S T E

• Used for high-luster polishing & stain removal • Non-splatter, consistent formula • 1.23% fluoride ion • Four grits & six tasty flavors (mint, bubble gum, cherry, raspberry, piña colada, & orange sherbet) •

www.keystoneindustries.com

TO ORDER, CALL: 1.800.333.3131

Keystone Industries

SPONSORED

High-Quality Prophy Paste Gelato Prophy Paste was created and designed with dental hygienists’ needs in mind. The main goal of the product is to allow easy use for the dental hygienist with great results and to give the patient a satisfying experience. This is made possible by being able to apply Gelato smoothly without any splatter, all while coming in six delicious flavors including pina colada, bubble gum, cherry, mint, raspberry, and orange sherbet.

The 1.23% fluoride ion Gelato paste comes packaged in 200-count boxes of single-use cups for convenient use and to eliminate cross-contamination. Gelato is also available in four different grits: fine, medium, coarse and x-coarse. More buying options are available as well, such as 6-ounce (exports only) and 12-ounce jars.

In the clinical research conducted on Gelato, 35 consultants used the product over 2,500 times and came to an overall

91-percent clinical rating. Among the consultants, 63-percent said they would switch to Gelato Prophy Paste, and 80-percent said they would recommend it to dental professionals.

Consultants involved in the clinical testing also remarked that Gelato Prophy Paste “does not splatter”, “is easy to rinse”, and “cups are color-coded and easy to open”.

“We take great pride in being able to offer the best dollar value on our prophy paste even after its won such prestigious awards. It really begs us to ask those who haven’t tried it the question, ‘Why not?’,” said Derek Keene, Vice President of Marketing and Product Development at Keystone Industries.

For more information on why dentists and patients love Gelato Prophy Paste, or to receive a free sample, visit keystoneindustries.com www.firstimpressionsmag.com

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QUICKBYTES

Editor’s Note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, First Impressions will profile the latest developments in software and gadgets that reps can use for work and play.

Technology News Charge it Valencia, California-based Naztech announced the release of its 18W Super Speed Wall Charger, which it says provides the latest high-speed charging technology – USB-C Power Delivery and Adaptive Fast Charging – in a single charger. Both of the charger’s ports deliver up to 18W output and can accommodate all USB-powered devices, including smartphones, tablets, wearables and USB-C laptops. The 18W USB-C PD + AFC Wall Charger is able to quick-charge an iPhone X/8 or Samsung Galaxy 9/9+ from

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0 percent to 50 percent in 30 minutes. According to Naztech, the USB PD, or USB Power Delivery protocol, is designed to standardize charging across the latest and future USB electronics. Everything from smartphones and tablets, to high-powered laptops, will soon be able to charge from a single device, reducing the need to carry around an assortment of cables and chargers. USB-C PD technology can charge a smartphone up to 80 percent faster than standard USB chargers, and automatically adjusts to deliver the exact power needed for the fastest possible charge.

Smart deadbolt

Net neutrality? Not a chance.

Schlage, the door hardware maker, announced that homeowners can access their Schlage Sense™ Smart Deadbolt using Google Assistant. This functionality can be activated by saying, “OK Google, lock my door” or “OK Google, is my door locked?”

The capability of Google Assistant will also extend to Android™ phones or the Google Assistant app on Apple® devices. Using the Schlage Sense Smart Deadbolt with Google Assistant-enabled devices will require the Schlage Sense™ Wi-Fi Adapter (sold separately). The Wi-Fi Adapter allows iOS and Android smartphone users to gain remote access to their lock through the Schlage Sense app with no monthly fee required.

“Net neutrality was too good for us,” writes Farhad Manjoo in The New York Times. “And even if rules are restored, the notion that the Internet should afford at least a minimally competitive landscape for new entrants now seems as antiquated as Friendster. Today, the Internet is run by giants. A handful of American tech behemoths – Amazon, Apple, Facebook, Google and Microsoft – control the most important digital infrastructure, while a handful of broadband companies – AT&T, Charter, Comcast and Verizon – control most of the Internet connections in the United States.

The very idea that large companies can’t dictate what happens online is laughable now. Large companies, today, pretty much are the Internet. In this world, net neutrality didn’t have a chance.”

Knotty problem solved ZIPPEAR is said to employ the power of magnets to prevent earphone cords from becoming tangled and knotted and to remain stylish and nicely bundled when put away. The product is an earphone accessory kit consisting of 10 small plastic clips that clip on your favorite pair of earphones. Each clip contains a small but powerful magnet. “I commute to work on a train every day, and as a music lover, I use my earphones a lot,” inventor Gal Avivi was quoted as saying.

“So I grew tired of having to untangle the cords each time I take them out of my bag.” ZIPPEAR has launched an Indiegogo campaign to spread awareness about their product among consumers and the investment community.

“ The very idea that large companies can’t dictate what happens online is laughable now. Large companies, today, pretty much are the Internet. In this world, net neutrality didn’t have a chance.”

Blackberry’s back TLC Communication – a smartphone manufacturer and BlackBerry-brand licensing partner – introduced the BlackBerry® KEY2. Running the latest Android™ 8.1 Oreo operating system, the BlackBerry KEY2 is the first-ever BlackBerry smartphone to feature a dual-rear camera. It also includes the introduction of Speed Key, a universal shortcut key that makes it possible to instantly access frequently used functions, apps and contacts anywhere on your device at any time. BlackBerry KEY2 has a redesigned intelligent keyboard as well as a 4.5-inch touch display that includes 2.5D Corning® Gorilla® Glass, said to offer increased scratch resistance and create a more seamless design and edge-to-edge look.

– Farhad Manjoo, The New York Times

Get my message?

Time-released messaging, by TimeSpring, Inc., enables people to share messages with anyone at any age, including children, up to 30 years into the future. Parents and grandparents can create accounts for children too young for email and send a photo or video with a message and have it scheduled to be delivered when the child is old enough to understand and appreciate the memory. The app works like this: Pick a photo or video, write a message, and schedule the date to be delivered to someone up to 30 years into the future. A reported 52 percent of TimeSpring users are sending messages between 10 and 20 years into the future, while the average TimeSpring user creates 1.5 child accounts. It seems, given the opportunity, people want to communicate their stories in the future, especially for their children, according to the company. TimeSpring can be installed for free in Google Play and Apple Store.

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REP CORNER

BY LAURA THILL

At Their Service Eric Meiners is driven to help others, whether he’s providing service to his dental customers, volunteering with his local fire department or bringing his skills to post-war Liberia.

Each Tuesday, Benco sales consultant Eric Meiners leaves work a little early and heads to the local fire station in Eden Prairie, Minn. A volunteer fire fighter, he is on duty until 8 the next morning, when he heads out to meet with dental customers.

Meiners admits he’s driven – driven to helping others, that is. “I’ve always enjoyed helping people,” he says, noting that his passion to serve others is far more motivating than any monetary goal. “That’s how I run my territory and my life. And it works.

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My dental customers sense I’m not there simply to make a sale, but to provide them with the right solutions.”

For a one-time biology major in college, it was somewhat serendipitous to land a position in dental sales. Meiners’ close family friend worked as an attorney for Patterson Dental and introduced him to the company. After working in the San Francisco Bay area for a couple of years, Meiners took a position with Dentsply and

returned to Minnesota. His next position was with a company called Marcus – later acquired by Benco Dental. “I just marked my 10-year anniversary at Benco,” he says. “I’ve enjoyed my career, as well as the opportunity to use my biology degree.”

A serious commitment Volunteering with the fire department is a serious commitment, according to Meiners. “I became an EMT in order to join the fire department,” he says. In addition to his EMT certification, he was required to complete eight months of firefighting coursework, followed by classes and training to prepare him to drive a fire truck and handle the various pieces of equipment. “We also have ongoing education and refresher classes and must attend a three-hour mandatory class every Thursday evening in order to meet National Fire Academy requirements,” he points out.

Teaching CPR classes – both to other volunteer fire fighters and his dental customers – helps him stay current, he adds.

“About eight years ago, I became a CPR for the American Heart Association with the intent of providing free classes to my customers,” he explains. Indeed, it’s common for Meiners to order lunch for the practice and spend about three hours training the dental team.

“With a job like this, I never know what I’ll be required to do from one night to the next,” he says of his role with the fire department. “I could be the truck driver, operate the pump or hose, or I could be responsible for putting the whole plan in motion.” Generally, they bid their role while on the truck, driving to the scene of an emergency, he notes. The senior crew person is usually the crew leader, and the first truck on the scene makes the initial decisions, such as whether or not to call for back-up.

“ I’ve always enjoyed helping people. That’s how I run my territory and my life.”

– Eric Meiners, Benco sales consultant

“We usually have more trucks on the way, so I may be first in command until the fire chief or one of his four assistants shows up,” he says.

About 90 percent of the firefighters in Minnesota are volunteers; Eden Prairie’s department alone includes about 110 people. “Our primary jurisdiction is Eden Prairie, but we have an agreement with our neighboring communities,” he explains.

“We all use similar equipment and follow the same protocols, and multiple dispatchers will get the same emergency call. Fire

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REP CORNER

“ I especially enjoy working with some of the newer [medical] technology,” he says, referring to the LUCAS™ chest compression system, which administers regular, automatic chest compressions.

“My fire chief saw more lives saved in the first 1 years we used this device than in his entire career.”

– Eric Meiners, Benco sales consultant

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fighters are better off having as many resources on hand as possible. We can always cancel a backup crew if we don’t need them.” Although it’s common to be called out on two or three calls each Tuesday night, as fire safety and sprinkling systems have improved, fewer and fewer are fire-related, he notes.

When duty calls Like many in public service, a truly committed firefighter is always on call. So, it’s little surprise that Meiners once found

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himself racing over country roads in rural Minnesota, chasing a trail of smoke. “I was on my way to Duluth to meet a customer, when I saw smoke,” he recalls. We are trained to read smoke, and based on its color, speed, etc., I suspected this was a house fire.” After a moment’s debate, he changed his course to pursue the fire and ensure the homeowner’s safety.

The structure on fire turned out not to be an actual house, but an outpost building behind a house. “I called 911, but the area was so rural, I had no idea

where I was,” he says, recalling retracing his steps to track down a street marker.

“While I waited for the firefighters to arrive, I pounded on the door to make sure no one was inside.

The fire truck arrived within minutes, but it wasn’t the crew Meiners anticipated.

“One person showed up in an old-fashioned fire truck! So, there I was in my suit, helping man the hose!” When the backup trucks finally arrived, the volunteer crew appeared in mismatched clothing – quite a contrast from the high-tech gear provided for the Eden Prairie department.

As it turned out, it was the local fire chief’s property that caught fire that day.

“Back then, we would get credit for assisting with fires,” says Meiners. “Once the fire was put out, I jokingly asked the fire chief if he could call my chief to ensure I got my credit. Then I headed on to my sales call, smelling of smoke.

“The next day, both my fire chief and the other fire chief called me with questions,” he continues. It didn’t take him long to realize he was actually a suspect! “Here I thought they were going to hand me a key to the city,” he jokes. “I was the first person on the scene, and I guess it appeared I was having a good time manning the hose.”

All’s well that ends well – at least for Meiners. It quickly became apparent that the chief’s daughter’s ex-husband started the fire shortly after signing divorce papers.

Truth be told, Meiners likely was enjoying the spontaneity of helping put out the fire that day. He admits he likes being a volunteer firefighter as much as he enjoys working with his dental customers. “I especially enjoy working with some of the newer technology,” he says, referring to the LUCAS™ chest compression system, which administers regular, automatic chest compressions.

“My fire chief saw more lives saved in the first 1 ½ years we used this device than in his entire career.”

Taking his talents abroad When Meiners volunteered to work in Liberia for a couple of weeks in 2013 as a dental assistant and EMT, he anticipated being exposed to a vastly different culture and socioeconomic lifestyle. Indeed, the experience impacted him more than he could imagine.

“Liberia had just come off of a 17-year civil war,” he explains. “The buildings were covered in bullet holes and people were living in shacks.” Furthermore, the group of dental volunteers he was traveling with were under instruction to not leave their hotel, which was heavily guarded. “I wondered what I was getting into,” he recalls. A brief Internet

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REP CORNER

search informed him that much of Liberia was controlled by brutal warlords.

Nevertheless, Meiners was disappointed that he couldn’t explore the country, meet the locals and try their cuisine. Then he stumbled upon a fire chief from a neighboring suburb of Minneapolis, who was working to improve the Liberian fire service. “This chief turned out to be my chief’s best friend,” he says. “He advised me to reach out to the local team of firefighters in Liberia.” He did just that and was soon appointed to be a logistics specialist during his free time from his volunteer work as a dental assistant and EMT. “The firefighters in Liberia had no equipment, no fire gear and only three trucks in the whole country,” says Meiners. Although he was returning to the States soon, he was convinced he could assist the Liberian firefighter service.

“I joined a U.S. group called the Fire Rescue Alliance,” he continues. “We collected older gear from local fire departments and raised $40,000 to purchase an old fire truck in Wisconsin and ship it to Liberia. “The truck was about 20 or 30 years old, and we had it painted with the Liberian Fire Service logo.” The Fire Rescue Alliance also shipped an ambulance donated by Minnesota-based North Memorial Hospital, and the Liberian government, in turn, contributed $125,000 to the cause, making it possible for Meiners (as well as other volunteers) to return to Liberia twice more as a logistics specialist.

Meiners’ return trips to Liberia proved to be a rewarding experience.

“Our donated equipment, the ambulance and the fire truck were far more sophisticated than anything they had,” he says.” While we were there, we met with their government’s Secret Service officials to train them to use the medical equipment we sent, as well as on newer

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“ I joined a U.S. group called the Fire Rescue Alliance. We collected older gear from local fire departments and raised $40,000 to purchase an old fire truck in Wisconsin and ship it to Liberia. Our donated equipment, the ambulance and the fire truck were far more sophisticated than anything they had.”

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– Eric Meiners, Benco sales consultant

firefighting techniques. These people have no money, so the gear, outfits and equipment legitimized them.”

Whereas they used to show up in shorts and flipflops and put out fires with buckets of sand, now they felt – and acted – proud.

Unfortunately, the Ebola outbreak put an end to the Fire Rescue Alliance’s missions to Liberia. “It was very sad because many of the Liberian firefighters we worked with were first responders during the Ebola outbreak, and they died helping ill people,” Meiners says. “In the end, we returned any unused money to the Liberian government. There is so much corruption there, we wanted to model the right way to do business.”

Currently, Meiners is working with a group called Helps International to provide aid to Guatemala. “I’ve gone there as a nurse, working with post-op patients to ensure their airways are open. We’ll work 16-hour days and complete 150 surgeries each week. I also help on the dental side. Benco and several manufacturers have helped with donations, and I’ve help set up the equipment in Guatemala. They have a big need there, and I know I can help.”

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HEALTHY REP

Health news and notes Gender disparities in care Research on disparities between how women and men are treated in medical settings is growing – and it is concerning for any woman seeking care, reports The New York Times. Research shows that both doctors and nurses prescribe less pain medication to women than men after surgery, even though women report more frequent and severe pain levels. And a University of Pennsylvania study found that women waited 16 minutes longer than men to receive pain medication when they visited an emergency room. Women are also more likely to be told their pain is “psychosomatic,” or influenced by emotional distress. And in a survey of more than 2,400 women with chronic pain, 83 percent said they felt they had experienced gender discrimination from their healthcare providers.

Eye care advances “Today’s clinical technologies to image the eye are pretty amazing, but they are undergoing tremendous advances,” Dr. Donald Miller, an expert in eye imaging technology at Indiana University, says in a recent National Institutes of Health newsletter. With new tools, eye health professionals may be able to catch disease even earlier. For example, Miller and his research team created a type of microscope to improve the diagnosis and treatment of glaucoma, which causes blindness by damaging nerve cells at the back of the eye. “The cells that get damaged by glaucoma are hard to see in the early stages of the disease,” Miller says.

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“With current technology, thousands of cells must die before it’s detected.” His team’s new method would allow eye doctors to see the damage earlier. In glaucoma, early treatment can often protect you against serious vision loss. Other eye imaging technologies are being developed to better detect age-related macular degeneration (AMD), the leading cause of vision loss and blindness nationwide among people age 50 and older.

The risks of gestational diabetes Gestational diabetes may predispose women to early-stage kidney damage, a precursor to chronic kidney disease, according to a study by researchers at the National Institutes of Health and other institutions. The study appears in the journal Diabetes Care. The researchers found that women who had gestational diabetes were more likely to have a high glomerular filtration rate (GFR), an estimate of how much blood per minute passes through the glomeruli, the tiny filters within kidneys that extract waste from the blood. Many researchers think that a very high GFR can precede the early kidney damage that accompanies pre-diabetes. “Our findings suggest that women who have had gestational diabetes may benefit from periodic checkups to detect early-stage kidney damage and receive subsequent treatment,” said the study’s senior author, Cuilin Zhang, M.D., M.P.H., Ph.D., of the Epidemiology Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

NEWS

Industry News Henry Schein partners with MLB players, Pro Baseball Athletic Trainers Society, Taylor Hooton Foundation to help kids live healthy lives Henry Schein Inc (Melville, NY) is joining with the Professional Baseball Athletic Trainers Society (PBATS), the Taylor Hooton Foundation, and Major League Baseball (MLB) players for the sixth consecutive year to help kids understand the importance of eating right, staying fit, making healthy choices, and visiting their doctor and dentist regularly. As part of PBATS’ Promoting a Lifetime of Activity for Youth (PLAY) Campaign, Team Schein and its partners are hosting events throughout the baseball season for children and teenagers at MLB stadiums. As part of its support, Henry Schein’s Athletics and Schools business and its supplier partners provide the approximately 200 children and teenagers who attend each event with a drawstring pack containing sunscreen, toothpaste, toothbrush, dental floss, Mueller’s No Glare Eye Black Strips, mouthguard, Thera-Band Exercise Bands, Clorox 2oz. Hand Sanitizer and Disinfecting Wipes On the Go, and a score card to track their teeth brushing, hand washing, and other healthy habits. The Henry Schein Cares Foundation also provides a monetary donation in support of the program.

Dental surgical instruments market projected to reach to $5.96B by 2023 A new report on ResearchAndMarkets.com finds that the dental surgical instruments market projected to reach to $5.96 billion by 2023 from estimated $4.48 billion in 2018 at a CAGR of 5.9%. Factors such as the rising incidence of dental diseases, increasing demand for cosmetic dentistry, increasing number of dental practitioners and dental clinics, and growing dental expenditure are expected to drive market growth during the forecast period. Asia Pacific is expected to witness the highest growth during the forecast period (2018 to 2023).

FDA launches water-line safety page The FDA has launched a new page on its website about dental unit water line safety. The page includes information for dental practitioners and manufacturers on the risks of waterline contamination, mitigation the risks, and the importance of infection control to

minimize the risk of patient infection. The page also provides tips for monitoring water quality and maintaining water lines.

Crosstex International Inc launches Syclone Amalgam Separator Cantel Medical Corp (Hauppauge, NY) subsidiary Crosstex International Inc launched Syclone Amalgam Separator, previously marketed and sold under the brand name, Apavia Amalgam Separator. This launch marks the company’s entry into dental wastewater management market. This new filtration technology and related assets were recently acquired from ENPRESS LLC and its subsidiary Apavia LLC. The Syclone Amalgam Separator will be available for customers in the coming months.

Hu-Friedy Partners with igniteDDS and igniteDA to enhance dental education Hu-Friedy, igniteDDS, and igniteDA are teaming up to provide dental students and dental professionals with resources to excel in their careers, according to a release. As part of the partnership, the organizations are formally announcing an exciting new video series, “In-Clinic at Hu-Friedy.” Filmed at Hu-Friedy’s state-of-the-art showroom in Des Plaines, Illinois, the video series features a practical, hands-on approach to key topics in dentistry, such as ways to improve visual acuity, the dangers of re-tipping instruments, and best practices for infection prevention. Hu-Friedy has a century-long history of supporting dental education by providing schools with specially-designed instrumentation kits and classroom demonstrations. The company also offers continuing education webinars, live lectures, and the Friends of Hu-Friedy online community. This video series and partnership is simply the latest manifestation of this ongoing commitment. “Partnering with igniteDDS and igniteDA was an obvious choice,” says Hu-Friedy Chief Marketing Officer, Patrick Bernardi. “Hu-Friedy is dedicated to being a trusted and relevant part of our customers’ professional lives from the time they’re a student, to the point they transition into practice, and all the way through to retirement. By teaming up with igniteDDS and igniteDA, our three organizations can help the next generation of dental clinicians perform at their best.”

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Henry Schein Appointee Announcements Monetta Reyes, Field Sales Consultant Monetta will represent Henry Schein in the Houston, Texas region. She’s been in the dental field for 36 years. She is a consistent top award winner in dental sales, and spends her free time making a difference as a speaker and entrepreneur.

Kyle Blair, Digital Technology Specialist Blair will represent Henry Schein in the Cleveland territory. He is new to the dental field and previously worked for US Endoscopy for two years as an Inside Product Specialist.

Bri Berzsenyi, Field Sales Consultant Bri will be representing Henry Schein in the San Antonio, Texas region. She recently graduated from Texas State University with her degree in Marketing with a concentration in Professional Sales.

Morgan Eason, Field Sales Consultant Eason will be representing Henry Schein in the Little Rock, Arkansas region. She is a recent graduate of Texas State University where she was very involved on campus, and graduated with a degree in Marketing with a concentration in Professional Sales.

Anna Ostrowski, Field Sales Consultant Anna will be representing Henry Schein in the Dallas/Fort Worth area. She is new to the dental field and is joining the Henry Schein team having spent one year as a Marketing Coordinator at 7 Rivers Alliance. She has a degree in Marketing from the University of Wisconsin – La Crosse, where she held the role of President for the University’s chapter of the collegiate American Marketing Association.

Bobby Dimovski, Field Sales Consultant Bobby will be representing Henry Schein in the Detroit, Michigan area. He has five years of experience in the dental field, one of which he spent as a Territory Sales Manager for another distributor.

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Jason M. Gosselin, Equipment Sales Specialist Gosselin will be representing Henry Schein in the North East Zone. He has 14 years of experience in the dental field, over 4 of which he spent working for another distributor as an Equipment Specialist.

Mehdi Azarshahi, Digital Technology Specialist Mehdi will be representing Henry Schein in the Southern California/ North Los Angeles region. He has 20 years in the dental field, 12 of which he spent as a CAD/CAM specialist for another distributor, where he was recognized as a top performer.

Brittany Mercadante, Field Sales Consultant Brittany will be representing Henry Schein in the Jacksonville, Florida region. She is new to the workforce.

Nick Yanakas, Field Sales Consultant Yanakas will be representing Henry Schein Dental in the Northern Virginia region. He is new to the dental field, and previously worked as a financial advisor for Northwestern Mutual.

Jeremy Ward, Field Sales Consultant Ward will be representing Henry Schein Dental in Orange and South Bay, California. He is new to the dental field and previously worked as a personal trainer at Iron Bodies Gym. Andrew McCormick, Field Sales Consultant Andrew will be representing Henry Schein Dental in the Louisville, Kentucky region. He is joining Henry Schein after a successful sales internship with the Company.

Eileen Boren, Field Sales Consultant Eileen will be representing Henry Schein Dental in the Phoenix, Arizona region. She has 20 years of experience in the dental field, which she spent holding several roles with Dexis LLC and Vogel Dental including: Certified Dexis Trainer, Kavo Kerr Trainer, Lead Dental Assistant, Program Director Share a Smile.

Harry McLaney, Field Sales Consultant Harry will be representing Henry Schein Dental in the Philadelphia – South Jersey region. He has a year of experience in the dental field and previously worked as a Pharmaceutical Sales Representative for Iqvia.

Tyler Doane, Field Sales Consultant Tyler will be representing Henry Schein Dental in the Chicago, IL region. He is new to the dental field and previously participated in the Sales Development Program at Textron Inc. Michael Florczykowski, Field Sales Consultant Michael will be representing Henry Schein in the Harrisburg, PA region. He is new to the dental field and previously worked for The Lincoln Electric Company as a Welding Design Engineer.

Courtney Kotoch, Field Sales Consultant Courtney will be representing Henry Schein Dental in the Denver, CO region. She is new to the dental field and previously worked for Gartner as a Business Development Coordinator.

Ali Cochran, Field Sales Consultant Ali will be representing Henry Schein Dental in the Chicago, IL region. She is new to the dental field and previously worked as a Human Resources Assistant for Federal Realty Investment.

Mike Kolb, Digital Technology Specialist Mike will be representing Henry Schein Dental in the San Diego, CA region. He has 15 years of experience in the dental field, six of which he spent as an IO Representative for Sirona.

Mark Russell, Field Sales Consultant Mark will be representing Henry Schein in the New Orleans, LA region. He has 20 years of experience in the dental field, 10 of which he spent as a Territory Representative for another distributor.

Mackenzie Riechers, Field Sales Consultant Mackenzie will be representing Henry Schein in the Omaha, Nebraska region. She is new to the dental field and previously completed an internship with United Technologies.

Dana Bezanis, Field Sales Consultant Dana will be representing Henry Schein in the Milwaukee West region. She is new to the dental field and previously worked as a Sales Account Executive for the Vindette.

Alicia Matton, Field Sales Consultant Alicia will be representing Henry Schein Dental in the Long Island, NY region. She is new to the dental field and previously worked at Columbia Bank as an Analyst.

Jason Christopherson, Field Sales Consultant Jason will be representing Henry Schein in the Grand Rapids, Michigan region. He is new to the dental field and has spent the last 17 years as a Specialty Sales Representative focusing on injectable insulins for Sanofi and Schering Pharmaceuticals.

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NEWS

Benco Dental New Appointees Kelly Brookbank, Territory Representative Benco Dental is pleased to welcome Kelly Brookbank to its Carolinas region. Brookbank earned a Bachelor’s degree at the Baylor University and brings nine years of industry experience to the Benco family.

Adam Schick, Territory Representative The Benco Dental team in the North Central region welcomes Adam Schick. Schick earned a degree in sports and recreation management from the University of Iowa. She brings two years of sales experience to Benco.

Kate Cairl, Territory Representative Kate Cairl joins Benco Dental in the Citrus region.

Cairl earned a Bachelor’s degree from the Florida State University. She brings 6 years of sales experience to Benco customers in her region.

Matt Davies, Territory Representative Matt Davies joins Benco Dental in the Lone Star region. Davies earned a BBA degree from the University of Houston. He brings two years of sales experience to the Benco family in Texas.

Mica Callaway, Territory Representative The Benco Dental team in the Peachtree region welcomes Mica Callaway. Callaway, a Certified Dental Assistant, earned certification from the Concorde Career College and earned a degree in healthcare management from American Intercontinental University. She brings five years of dental industry experience to Benco.

Kyle Schmitz, Territory Representative Kyle Schmitz joins Benco Dental in the Midway region. Schmitz, attended North Central University and brings seven years of sales experience to the Benco family.

Rachel Finkle, Territory Representative Rachel Finkle joins Benco Dental in the Gotham region. Finkle studied at State University of New York, Albany.

Grey Bonin, Territory Representative Benco Dental is pleased to welcome Bonin to its Lone Star region. He earned a B.S. in biomedical sciences at Texas A&M University and brings three years of sales experience to Benco customers.

Ashley Keen, Territory Representative Ashley Keen joins Benco Dental in the Peachtree region. Keen earned a degree in general business and marketing at Georgia Southern University and brings two years of sales experience to Benco customers.

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Gabrielle Szekely, Territory Representative Benco Dental is pleased to welcome Gabrielle Szekely to its Liberty region. Szekely, a Registered Dental Hygienist, earned an Associate’s degree in allied health. The CPR trainer brings 23 years of dental experience to the Benco family.

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