Fi jan18

A par tnered publication with Dental Sales Pro • www.dentalsalespro.com

For Dental Sales Professionals

Nitrous Oxide More dentists are finding that nitrous oxide leads to enhanced patient satisfaction, efficiency and revenues.

January 2018

NSK America Corp.

1800 Global Parkway, Hoffman Estates, IL 60192, USA

TEL: +1 888 675 1675

FAX: +1 800 838 9328

FOR DENTAL SALES PROFESSIONALS

Editorial Staff Editor Laura Thill lthill@sharemovingmedia.com Managing Editor Graham Garrison ggarrison@sharemovingmedia.com Founder Brian Taylor btaylor@sharemovingmedia.com Publisher Bill Neumann wneumann@sharemovingmedia.com Senior Director of Business Development Diana Craig dcraig@sharemovingmedia.com Director of Business Development Jamie Falasz jfalasz@sharemovingmedia.com Art Director Brent Cashman bcashman@sharemovingmedia.com Circulation Wai Bun Cheung wcheung@sharemovingmedia.com

4

JANUARY 2018

Piped vs. Portables Piped nitrous oxide systems often offer the best solution – provided they are properly installed.

Nitrous Oxide and Oxygen Sedation More dentists are finding that nitrous oxide leads to enhanced patient satisfaction, efficiency and revenues.

10 12

Healthy Reps

Health news and notes

Windshield Time

Automotive-related news

14 16

Quickbytes

Technology news

Pain Management

Improved technology and delivery systems have made it easier for dentists to keep patients comfortable and calm

Associate Editor Alan Cherry acherry@sharemovingmedia.com First Impressions Digital Edition is published 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 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.

www.firstimpressionsmag.com

First Impressions

January 2018

3

4

January 2018

First Impressions

www.firstimpressionsmag.com

Piped vs. Portables Piped nitrous oxide systems often offer the best solution – provided they are properly installed.

BY LAURA THILL

More and more dental offices rely on nitrous oxide/oxygen sedation to reduce patients’ anxiety and help them relax during complex dental procedures. For offices that use nitrous oxide/oxygen sedation even a few times each week, piped – or plumbed – systems could offer the most efficient and economical solution.

Although there is an upfront cost for piping a nitrous oxide/ oxygen sedation system (i.e., the cost of a medical gas plumber, copper piping, a manifold system, zone valve emergency shut off systems, if required, and a verification/inspection fee), there are long-term cost savings and benefits of which some clinicians might not be aware, notes Michael Civitello, sales manager, Porter Instrument. “It makes sense for dentists to sit down and evaluate the long-term benefits before making a decision that they may later regret,” he points out.

In some cases, portable e-cylinder carts continue to offer a viable solution, he continues. He recommends portable systems when: • The dental office is already built, and there are no options for running piping through a drop ceiling or basement.

• The current dental owner will only be at that location for a couple of more years, after which he/she plans to build a new office or stay on as an associate.

• The office has no plans to incorporate nitrous oxide/oxygen sedation into its regular routine, and only expects to use it a few times each year.

For dental offices looking to offer nitrous oxide/oxygen sedation more routinely, however, there are a number of benefits to adding piped or plumbed nitrous oxide systems, says Civitello, including: • The cost of gas from larger H/G type cylinders compared with E size can easily equate to a $10 savings per patient on the gas itself. “Multiply that times the number of uses per week, and calculate that out over five, 10 or 20 years. It’s a large expense.”

• Portable e-cylinder systems may seem like a good idea, but compared to a centrally plumbed system, many dentists (as well as assistants) often find reasons to not use them. Portable systems are never ready for use; often

are located in another room; require a constant change of cylinders; and take up valuable floor space. In addition, the cylinders generally arrive from the gas suppliers dirty and rusty, and they will be in plain sight of their patients.

• With a central system, every operatory is ready for nitrous use. Having operatories set up for all types of uses helps avoid situations where one case may run long and the office must move a scheduled patient to another operatory, where nitrous may not be available. “Dentists don’t want to be in a position where they are unable to provide nitrous to patients who want or need it.”

• If nitrous oxide/oxygen sedation is easier to use, it will be used more often. “The whole reason to have a nitrous system is to provide comfort and relaxation for patients, while at the same time make it easier for the dentist to provide the treatment. Dentists who have easy access to nitrous oxide/oxygen sedation are likely to offer it to their patients more often, in situations where it could be beneficial.”

• Offices that can offer nitrous oxide – and, in turn, offer their patients a more comfortable, relaxed experience – can make a positive impression and facilitate more return visits. “Patients draw conclusions quickly based on what an office looks like and how it is set up. For instance, is it clean? Does it have modern equipment? That said, does the dentist really want to wheel in a portable cart that has rusty and dirty cylinders and various hoses hanging from it? Or would he/she rather have a built-in professional looking system that is designed for the space?”

• Nitrous oxide can be very profitable for a practice.

When centrally plumbed, the per-patient cost is very low, particularly when one considers the concurrent fees the office may charge (on average, $75). And, when patients are satisfied with their care, they are more likely to complete – or follow up with – their treatment, return for future care and refer their family and friends to the practice.

www.firstimpressionsmag.com

First Impressions

January 2018

5

NITROUS OXIDE • Many states are adopting expanded duties certifications for hygienists, permitting those who are qualified to administer nitrous oxide, provided the dentist is on site.

“Think of the additional profit the hygienist can produce by offering nitrous oxide to every patient. This isn’t easy to do with a portable E-cylinder cart.”

• As more general dentists bring in specialists to their offices, who rely on nitrous oxide/oxygen sedation, an accessible piped-in system is more important than ever.

It’s never too early for dentists to start planning their exit strategy, and piped nitrous oxide should be part of it, Civitello adds. “If dentists plan to sell their practice at some point, they should keep in mind that it may not attract specialists, such as pediatric dentists or oral surgeons, who are used to relying on easy access to piped nitrous oxide.”

Rely on the experts Manufacturer equipment specialists can ensure that piped nitrous oxide systems are installed correctly and safely, and dentists and their sales reps should involve their nitrous equipment manufacturer representative early in the process, notes Civitello.

“There are many flowmeter options from which dentists can choose, as well as several installation options,” he points out.

Once the needs of the practice and the design of its operatories are clear, the manufacturer rep/equipment specialist can recommend the best possible solutions, as well as advise on what is required from a code perspective. “Many Porter representatives have an ASSE 6005 Medical Gas System Generalist certification, which is essentially the same course that a Certified Medical Gas Plumber takes (without the hands-on/brazing portion).”

Equipment specialists can work with a dental office to address a number of important points, including: • Flush mount flowmeters. It’s important to consider the style and type of cabinetry in which the flowmeter will be installed, as not all flowmeters fit in all cabinets. The manufacturers rep can advise which flowmeter will work best in each cabinet style, and how best to position the flowmeter.

•O utlet stations. If using outlet stations, it is critical to plan where the outlets will be located. Installing outlets on the wrong side of the room can be a disaster.

• Piping. It is essential to pipe all operatories, even if they are not being set up with a flowmeter. Non-functional operatories can be piped, with a termination-point shut-off valve installed. If at some point the practice wishes to expand, the piping is in the wall; it will be easy to access the piping and connect a flowmeter. (If an operatory is not

6

January 2018

First Impressions

www.firstimpressionsmag.com

piped, and the office decides to expand, it must bring in a medical gas plumber to cut pipes, rip open walls, etc.)

• Detached tank room. When the tank room is detached from the main office, both an automatic changeover manifold and zone valve will be required. An example of this would be a tank room in the basement or in a storage room located outside the main building (with no internal door from the main office to access).

Dentists should consider installing an automatic changeover manifold, rather than a manual changeover manifold, notes Civitello.

“The manual changeover manifold may appear to save them some money,” he says. But, with this option, when the cylinder is empty, someone must go to the tank room to close one cylinder and open another, wasting time. It can be disruptive to a patient’s procedure and inevitably lose the practice money. “With an autochangeover manifold, when one cylinder runs low, it automatically switches to a full cylinder,” he says. “There is no disruption in the patient procedure, nor does anyone have to go to the tank room.”

An experienced manufacturer rep can also ensure that the piped nitrous oxide system is installed by a properly certified plumber, and inspected by an independent third party, Civitello continues. “It’s important that only a certified medical gas plumber works on the piping system,” he says. “These plumbers have an ASSE 6010 certification. They are required to carry an identification card at all times and are the only ones allowed to handle the piping and installation.” In fact, they can’t have an apprentice assist them unless that individual is ASSE 6010 certified, he points out.

“Dentists and/or general contractors absolutely should not hire Joe the plumber who is trained to fix toilets. This is where major mistakes can happen, and it can cost patients their life.”

The piping system must be inspected by an independent verifier, notes Civitello. “This cannot be the person who did the installation, and he or she must have an ASSE 6030 medical gas system verifier certification. Dentists and/or general contractors cannot skip the verification to save $1,000. This is required.”

Installation is not complete until both the medical gas plumber and medical gas verifier have conducted all required safety and functional tests, including the crossed lines test, he adds. “In the end, these documents must be turned over to the dentist.”

Offices that can offer nitrous oxide – and, in turn, offer their patients a more comfortable, relaxed experience – can make a positive impression and facilitate more return visits.

Nitrous Oxide and Oxygen Sedation More dentists are finding that nitrous oxide leads to enhanced patient satisfaction, efficiency and revenues.

BY LAURA THILL

When patients enter into treatment feeling com-

fortable, relaxed and confident, they are more likely to cooperate and follow through with their plan – and, there’s a good chance they’ll refer family and friends to the practice. From the solo office to elite DSOs, “the use of nitrous oxide in dentistry – commonly used to reduce anxiety, or to increase analgesia, relaxation, and cooperation levels of patients – can also be useful for prolonged or more complex dental procedures, as well as for patients with hyper-responsive gag reflexes or low pain tolerance,” according to Leann Keefer, RDH, MSM, director, corporate education & professional relations, Crosstex. The use of nitrous oxide/oxygen sedation is a “practice builder, enabling patients with dental fears or certain medical or mental conditions to get the treatment they need,” she says.

“Patients tend to be more relaxed and comfortable, because nitrous oxide can reduce their anxiety and assist them with pain management.”

Relaxed patients are less likely to cancel their appointment and procedures often run more efficiently, she continues. That means each office can schedule an additional patient appointment each day, realize cost savings and add revenues.

The science behind the technology Enhancements in technology have made it increasingly safer and more efficient for dentists to administer nitrous oxide.

Nitrous oxide/oxygen flowmeters have traditionally relied on needle valves and glass tubes to control the flow of gas, according to Keefer. Today’s systems feature flat screen displays; digital, touch pad controls that offer greater accuracy over longer time frames; and enhancements in infection control. As such, it’s important for clinicians to stay up-to-date and educated about the process.

www.firstimpressionsmag.com

First Impressions

January 2018

7

NITROUS OXIDE Nitrous oxide continues to be administered by inhalation, absorbed by diffusion through the lungs and eliminated via respiration, she notes. Proper equipment for monitoring, and storage unit integrity, are necessary in order to avoid unintended gas leakage or excessive exposure. In addition, clinicians should be educated on the various components of a nitrous oxide/oxygen sedation system: •N itrous oxide is stored in closed gas cylinders. Oxygen and nitrous oxide are part of the required equipment.

•R egulators ensure safe delivery of gas to the patient by reducing/controlling the pressure from the cylinders.

• Manifolds in a central delivery system connect several large cylinders of gas together, ensuring the constant availability of gas to each treatment room through copper lines within the walls of the building.

• I n a portable system, a yoke stand is the metal framework on which the equipment rests and is easily moved on wheels to different areas of the dental office.

• Flowmeters are highly calibrated devices designed to indicate the amount of gas being delivered to the patient. Flowmeters further reduce the pressure level to local atmospheric pressure, and restrict the proportion as well as the flow rate of nitrous oxide with a fail-safe mechanism to keep a minimum oxygen concentration of 30 percent.

• The reservoir bag contains the gas mixture being delivered to the patient.

• Gas is delivered through conduction tubing, which runs from the delivery unit and attaches to the breathing apparatus.

• The capnography device monitors patient breathing by measuring the actual CO2 in the patient’s exhalation.

• A specially designed nasal mask/hood fits snugly around – and fully covers – the patient’s nose, allowing the mixture of nitrous oxide with oxygen to flow, while providing complete access to the patient’s mouth. Single-use, disposable masks are preferred to reduce the spread of infection. Disposable masks today are available in various designs and sizes, as well as patient-friendly scents like vanilla, strawberry, mint, grape, and bubblegum. Newer low-profile masks provide unencumbered access, with a small lightweight scavenging system, which is easier to work around than the traditional masks and co-regulated hoses, and contributes to more efficient care and reduced chair time. While traditional masks are opaque, some newer nasal hoods are translucent, allowing clinicians to visually monitor their patient’s breathing.

8

January 2018

First Impressions

www.firstimpressionsmag.com

Resolution 37 In October 2016, the passing of Resolution 37 at the American Dental Association’s (ADA) annual meeting called for revisions to safety regulations for providing anesthesia and sedation, according to Keefer. The rules and regulations for nitrous oxide sedation largely remain the same in light of Resolution 37, she explains.

“Healthcare providers are required to complete 14 hours of CE for N2O/O2 alone and 16 hours for N2O/O2 combined with a single-dose sedative up to the MRD. MRD is maximum FDArecommended dose of a drug for unmonitored home use.

“Sedation levels deeper than what are typically found with nitrous oxide (minimal sedation) now require considerably more training than in the past,” she continues. “Performing oral, intravenous or any other method of moderate sedation now requires a 60hour course and at least 20 patients. Previously, only a 24-hour, 10-patient course was needed. Dentists who were already practicing sedation dentistry before the guidelines [were issued] are now required to be re-trained and will not be grandfathered in as in the past. Critics of the resolution cite the financial impact of the new regulation, as the increased training will drive costs up, preventing dentists from pursuing advanced sedation training.

“Resolution 37 is only a guideline and the ADA has no enforcement authority,” Keffer explains. However, most state dental boards will adapt the ADA guidelines in drafting their own regulations. “Dentists offering sedation can vastly expand the scope of their practice,” she says. “Yet, probably fewer general dentists will elect to go through the trouble and expense to get their moderate sedation certification. Following the dramatic increase in training required for deeper states of sedation, many will limit their practice to nitrous oxide, with or without a single-dose oral sedative up to the MRD.”

Newer low-profile masks provide unencumbered access, with a small lightweight scavenging system, which is easier to work around than the traditional masks and coregulated hoses, and contributes to more efficient care and reduced chair time.

Regular service, enhanced safety and longer life expectancy It is important for dental offices to have their nitrous oxide and sedation equipment serviced and calibrated at a minimum every two

years, notes Keefer. Doing so can help avoid the potential for leakage and ensure the equipment is safe to use, as well as ensure it runs efficiently for 15-20 years. “Manufacturers recommend various levels of maintenance and service for their units, including routine, preventive, scheduled and recalibration,” she says. In addition to recalibration, service protocols should include pressure testing and internal component integrity/replacement, as well as any other necessary factory testing procedures. Clinicians should refer to the specific manufacturer’s IFU (Instructions For Use) and follow the recommendations to ensure safe use and delivery of NO2/O2 for patients and staff.

The service and inspection of anesthetic gas equipment should be performed by qualified service personnel.”

An investment for the practice Implementing nitrous oxide/oxygen sedation in a dental practice – no matter how small or large – can quickly become a source of revenue, as well as help the practice address the needs of patients anxious about their pain management.

(The current ADA/CDT-4 code for billing dental procedures using nitrous oxide/ oxygen sedation is 09230.)

There are two options for delivering nitrous oxide, notes Keefer: portable units and central systems. “Portable – or selfcontained units – can cost between $3,500 for a two-cylinder system to $8,000 for a four-cylinder, enclosed system,” she says, noting that portable systems are recommended for offices that only occasionally use nitrous oxide/oxygen sedation.

The cost of centrally installed systems – which are recommended for practices that routinely implement nitrous oxide/ oxygen sedation – ranges from $2,500 to $4,000 per operatory, with a total average cost of $28,000 for a mid-sized office, notes Keefer. “Although the initial set-up costs are high, the central system

A conversation starter Sales reps can initiate a discussion about nitrous oxide with their dental customers by asking a few probing questions: • “Doctor, do you currently offer N2O/O2 sedation?”

• “If not, can you tell me why?”

• “If so, how often is it used per week?”

• “Do you charge a fee?”

• “Do you consider your patients’ comfort levels valuable?”

• “Are you less stressed when your patients are relaxed and cooperative?”

• “Are you aware that by implementing nitrous oxide at your practice, you can potentially generate about a $30,000 profit annually, simply by using it just 3-4 times each day?”

• “Have you considered the number of potential new patients who might call your practice to inquire whether you offer nitrous oxide/oxygen sedation, and how many might not schedule an appointment if you do not offer it?”

• “Have you seen the Digital Ultra Flushmount Flowmeter

by Crosstex/Accutron?”

• “Have you seen the new Crosstex/Accutron Axess LOW PROFILE Nasal Mask?”

Indeed, when a dental practice considers that the use of nitrous oxide/oxygen sedation systems helps patients relax in the chair – thereby reducing patient chair time and increasing office efficiency – and leads to greater revenue, most clinicians will agree it’s a worthwhile investment.

is more cost-effective in the long run,” she points out. “The smaller E cylinders of a portable system are approximately five times more expensive than the larger G or H cylinders, due to the high cost of packaging the gases. In addition, the centralized system is more convenient, as it minimizes the need to change cylinders frequently. Not only are the cylinders larger than those of a portable system, several cylinders can be connected via a manifold system. When one cylinder is depleted, the system automatically switches to the next available cylinder.”

Indeed, when a dental practice considers that the use of nitrous oxide/oxygen sedation systems helps patients relax in the chair – thereby reducing patient chair time and increasing office efficiency – and leads to greater revenue, most clinicians will agree it’s a worthwhile investment. At the end of the day, satisfied patients mean more return visits, more patient referrals and a greater bond with the community.

www.firstimpressionsmag.com

First Impressions

January 2018

9

HEALTHY REPS

Health news and notes Blood thinners are often prescribed to help prevent blood clots that can lead to pulmonary embolism, heart attack and stroke. Though effective at preventing these clots, warfarin can cause life-threatening bleeds. Warfarin has led to more emergency room visits for older people over the last decade than any other medication. This is because it can be difficult for doctors to determine the right dose. A team of scientists led by Dr. Brian F. Gage at Washington University in St. Louis investigated whether genetic testing can help predict the best warfarin dose to give a patient. They compared outcomes for patients whose initial doses were based on clinical information alone (e.g., age, weight, etc.) to those whose initial doses were based on their genetic makeup (genotype) along with clinical factors.

The researchers collected blood samples from the patients and screened for genetic differences in the genes VKORC1, CYP2C9, and CYP4F2, which are related to blood clotting and warfarin metabolism or sensitivity. Adverse events were tracked for 90 days, including major bleeding, deep vein thrombosis, and pulmonary embolism. There were fewer adverse events in the genotype-guided dosing group: 87 events, or 10.8 percent of the genetic group, versus 116 events, or 14.7 percent of the clinically guided group. No patient died during the study.

10

January 2018

First Impressions

www.firstimpressionsmag.com

Third dose of mumps vaccine?

With the U.S. facing a growing number of mumps outbreaks, an expert panel that advises the Centers for Disease Control and Prevention recommended that people who are at risk during outbreaks (such as those on college campuses) should receive an additional, third dose of vaccine, reports STAT. The Advisory Committee on Immunization Practices unanimously voted to approve a third dose of mumps-containing vaccine as a tool for outbreak control, despite acknowledging evidence to support the practice is limited. After years of low numbers of mumps cases – fewer than 1,000 cases nationally a year – the disease has made

a resurgence in the past decade. There were nearly 7,000 cases nationally in 2006 and more than 6,000 in 2016. As of early October, there were 4,667 cases in 47 states and the District of Columbia in 2017.

Memories are made of this Using an innovative “NeuroGrid” technology, scientists showed that sleep boosts communication between two brain regions whose connection is critical for the formation of memories. The work, published in Science, was partially funded by the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, a project of the National Institutes of Health. A brain structure called the hippocampus is widely thought to turn new information into permanent memories while we sleep. The study – involving rats – confirmed the presence of ripples in the hippocampus during sleep and found them in an area on the brain’s surface involved in processing complex sensory information. As a result, the researchers theorize that such communication is important for the creation and storage of memories, and they hope to use the NeuroGrid in people undergoing brain surgery to see if the same ripples occur.

One in four Americans aged 65+ falls each year, resulting in more than 2.8 million injuries treated in emergency departments annually, and more than 27,000 deaths, per the U.S. Centers for Disease Control and Prevention.

physical activity by an average of 160 percent from before the competition began, while those who regained their weight had only a 34 percent increase. The scientists calculated that an increase of about 80 minutes per day of moderate physical activity or 35 minutes per day of vigorous activity was necessary to maintain lost weight. These amounts are much greater than current recommendations for daily physical activity.

Heartburn: The lesser of two evils?

The recent rise in the use of stomach-acid-suppressing medications might be contributing to an increased incidence of chronic liver disease, according to a team of researchers led by Dr. Bernd Schnabl at the University of California San Diego School of Medicine. The researchers found that mice lacking stomach acid had higher levels of intestinal bacteria as well as imbalances among the microbes. In particular, the mice had increased levels of Enterococcus in their guts. Further experiments suggested that these bacteria can reach the liver, where they can cause liver inflammation and damage. The team looked at whether people taking proton pump inhibitors – heartburn medication – have similar microbiota changes. They collected fecal samples from healthy people before and after PPI treatment. After two weeks, those taking the PPI treatment also had a higher number of Enterococcus.

Steady as she goes One in four Americans aged 65+ falls each year, resulting in more than 2.8 million injuries treated in emergency departments annually, and more than 27,000 deaths, per the U.S. Centers for Disease Control and Prevention. The National Council on Aging leads the National Falls Prevention Resource Center, which supports awareness and educational efforts about falls, and promotes evidence-based falls-prevention programs (such as exercises). For more information, go to www.ncoa.org/fallsprevention

How do the biggest losers keep losing?

Vacation deprivation

Researchers have been working to understand which aspects of diet and physical activity are most important for weight control. A team led by Dr. Kevin D. Hall of the National Institutes of Health studied participants in a season of “The Biggest Loser,” a televised weight loss competition. Of 16 competitors enrolled, 14 participated in a follow-up study six years later. Seven participants had maintained an average weight loss of about 25 percent of their starting weight. The other seven returned to a weight that was within 1 percent of their starting weight. The calorie intake of both groups was similarly reduced from before the competition began. The main difference was in levels of physical activity. The weight loss maintainers increased their

Americans are struggling to use their vacation time, per Expedia.com’s Vacation Deprivation® report. Millennials are the most vacation-deprived age group (62 percent) and receive the least vacation time. They are also the most likely to shorten their trips due to impending workload (53 percent). But it’s not just millennials who are struggling to achieve work/life balance. Around half of workers in the U.S. report feeling somewhat or very vacation-deprived, and were projected to lose approximately 462 million vacation days in 2017. The primary reasons cited for not taking time off are budget (43 percent), the desire to save up vacation days for a longer holiday (30 percent), and not being able to get away from work (22 percent).

www.firstimpressionsmag.com

First Impressions

January 2018

11

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.

Automotiverelated news Car dealer of the future From Automotive News: The year is 2030, and the 10,000-squarefoot showrooms of the past are relics. So are many of the staffers who once worked in them. Those who remain need new skills to mirror the new realities of automotive retailing. Now, a few models of autonomous vehicles sit in the center of a tidy, tasteful and tiny showroom, available for purchase or subscription ride-hailing services. The vehicles are framed by just four desks where the transportation consultants – formerly called salespeople – work. Whether a customer buys an autonomous vehicle, or signs up for a subscription ride-hailing service, most transactions happen digitally, including virtual in-home test drives. On rare occasions, some customers visit the micro dealerships to touch the cars and work with a transportation consultant on a personalized subscription plan. The product presenters or transportation consultants understand the car, present its features online, arrange financing or payments, and deliver it if needed – tasks that go beyond today’s “Genius” staffers at BMW dealerships.

I want one of these You probably won’t need one of these to get around in your town, but it is cool thinking about it. The Tesla Semi is a full-size electric truck that can go from 0 to 60 mph towing 80,000 lbs., its max tow load, in 20 seconds, according to Tech Crunch. It can go 500 miles at highway speed, and it requires no shifting of gears (as is normal for most electric vehicles), with regenerative braking, which provides “basically infinite” brake life per Tesla.

One 30-minute charge will get you 400 miles. The driver is centered in the cab, with touchscreens on either side of him or her,

12

January 2018

First Impressions

www.firstimpressionsmag.com

offering navigation information, blind spot monitoring and trip data logging applications. Take advantage of the million-dollar warranty. And take pride in parking this beautiful vehicle in your driveway … or the nearest rest stop.

Self-driving shuttle buses Despite this fall’s fender bender involving a small driverless shuttle in Las Vegas, autonomous shuttles could become viable tools of mass transit, according to Wired magazine. They could be used on college campuses, in retirement communities, or to supplement public transportation in the suburbs. “Most transit authorities are looking for opportunities to answer the first-mile, last-mile question,” bridging the distance between transit hubs and people’s final destinations, Maurice Bell, Keolis North America’s head of mobility, was quoted as saying.

By the way, here’s how the fender bender in November occurred: The shuttle encountered a semi-truck backing out of an alleyway and stopped. It couldn’t back up, because there was a vehicle directly behind it. So it just sat there as the truck slowly backed into it. (The shuttle could have honked, a Keolis representative said, but didn’t because the truck’s trailer moved in a way that the autonomous system did not anticipate.)

Flying cars on demand Uber announced it wants to launch at least a few flying “cars” in Las Angeles in 2020, with a real commercial service to follow a few years later, reports Wired. Uber is reportedly working with aerospace partners at Embraer, Bell Helicopter, Pipistrel, Aurora Flight Sciences, and Mooney Aviation, to develop a drone.

Practice waste perfect.

Contact & Amalgam Non-Contact Capsules Amalgam

$100 off

Chair-Side Traps Teeth with Vacuum Amalgam Filters

The New NXT Hg5 Amalgam Separator *

Looking for the perfect system for managing dental waste?

Look no further.

Special Rebate Offer includes: • NXT Hg5 Collection Container with Recycle Kit

NXT Hg5 Amalgam Separator

PWS Amalgam Waste Bucket

• New compact design for easy and flexible installation • ISO 11143 certifed • Eco-friendly packaging is 100% recyclable

• Ensures compliance with new EPA Dental Amalgam Rule • Affordable, one-stop mail-back service • Purchase through your favorite dealer

The best in amalgam separation

• Includes a Practice Waste Solutions amalgam bucket • Certificates of compliance available 24/7 • Made in the USA

Now required by EPA Regulation

solmetex.com | 800.216.5505

• Practice Waste Solutions Amalgam Bucket • Solmetex AutoShip Program

Clearly the leader in amalgam separation

*PROMO CODE: 1IMP100. Offer valid through 03.15.18. Some restrictions apply. Visit solmetex.com/promotions for details.

Don’t expect the program to look like Uber’s ground service, at least not for a while. It’s likely the first flights will have to follow agreed-upon routes, such as above freeway corridors.

On-demand test drives A mobile used-car dealership in Nova Scotia is offering the opportunity for car buyers to inspect, test drive and purchase their next used-car from the comfort of their driveways. The service, Clutch, is only available to residents in the Halifax metro area.

How it works: Clutch captures high definition photographs of its used cars at their headquarters. Once listed on their website, anyone with a computer or smartphone can browse, book an athome inspection or test-drive and even get financing on Clutch’s proprietary buying platform. www.clutchcanada.com

How much longer?

Customers at automotive body repair shops can get a real-time update of the repair process via Carbeat™, a software application introduced by AkzoNobel’s Vehicle Refinishes business.

The application is deployed on a large touch-screen monitor, and provides a comprehensive overview of the work in production.

The company says Carbeat “enhances the quality and granularity of captured cycle time data, which enables deeper insight into ways to improve efficiency and eliminate waste.”

Cool dashcam Car and Driver magazine introduced a new dashcam – the MinioPro – featuring 1080P video capture, auto recording, a microSD drive with up to 64GB card capacity and a GPS antenna. While dashcams are often used to document time spent on the track, they also are increasingly essential as electronic evidence resolving disputes stemming from road incidents, according to the magazine. The MinioPro features a built-in motion sensor, which detects abrupt changes in vehicle speed and automatically captures a still image and locks in the five seconds prior to and subsequent to an incident. It is available at Best Buy with a suggested retail price of $200.

Formula E The first thing you notice about electric car racing is that it’s relatively quiet, according to the author of an article by the Consumer Technology Association. There is a high-pitched whining sound, but not nearly the eardrum-shattering blasts one gets at NASCAR races or from Indy cars. Formula E racing takes place in the world’s largest cities, right in the heart of the city. Hong Kong, Mexico City, Paris, Montreal, Marrakech and New York were on the calendar this year; Santiago, Rome and Sao Paolo are lining up for future races.

www.firstimpressionsmag.com

First Impressions

January 2018

13

QUICKBYTES

Editor’s Note: Technology is becoming an integral part of 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

14

Are you ready, boots?

For those long, long rides

UnitedHealthcare and Qualcomm Inc. have integrated wearable devices from Samsung Electronics America Inc. (Fit2 Pro and Gear Sport) and Garmin International Inc. (vivosmart® 3) into UnitedHealthcare Motion™, a national wellness program that provides eligible plan participants access to activity trackers and enables them to earn more than $1,000 per year by meeting certain daily walking goals. UnitedHealth says that Motion participants have collectively walked 130 billion steps, earning more than $19 million in incentives since the program began. The program enables employees to earn up to $4 per day in financial incentives based on achieving F.I.T. goals: 1) Frequency: complete 500 steps within seven minutes six times per day, at least an hour apart; 2) Intensity: complete 3,000 steps within 30 minutes; and 3) Tenacity: complete 10,000 total steps each day.

Naztech (www.naztech.com) introduced the Xtra Drive Mini, a thumb-sized, high-speed Micro SD card reader capable of up to 256GB of extra storage for iOS devices including the iPhone 8, iPhone 8 Plus and the iPhone X, as well as the iPad and iPod. It has a capacity of up to 170,000 photos, 74,000 songs, or 72 hours of video. Shows can be watched directly from the drive without using any of the Apple device’s own memory.

January 2018

First Impressions

www.firstimpressionsmag.com

Your personal physician The Apple watch doesn’t have a sphygmomanometer or polysomnographic equipment found in a sleep lab – but thanks to machine learning, it might be able to help with their work, reports Wired. Research presented at the American Heart

Startups to watch Some startups that could make your life easier and your business run smoother, per the Chicago Tribune: 1) Foodietrip (matches people looking for food tours with hosts for tastings); 2) Gadget Flow (shopping site for cutting edge products, including those from Kickstarter, Etsy, Amazon and IndieGoGo); 3) COSIGN (lets you click on objects, such as clothing, on a friend’s social media page and tells you where you can buy it); 4) globalVcard (could become the premier provider in digital payment); 5) Pindrop (neutralizes phone calls that are trying to steal someone’s identity); 6) Nowait (partners with Yelp to let you virtually stand in line at a restaurant); and 7) Bellhops (active in 50 cities, hooks you up with college kids who are willing to move your stuff).

Do it yourself

Association meeting in Anaheim claims that, when paired with the right machine-learning algorithms, the Apple Watch’s heart-rate sensor and step counter can make a fair prediction of whether a person has high blood pressure or sleep apnea. The new study adds to evidence that the right algorithms might transform the Apple Watch from personal trainer to personal physician.

Weekend deals Apple is offering a feature to the App Store called “This Weekend Only,” which lists deals that can be found inside apps, as opposed to discounts on downloads of apps themselves, according to TechCrunch. Every Thursday, users will find on the Apps tab an app labeled “This Weekend Only,” with promotions valid through Sunday.

BITalino is a set of hardware and software ingredients that allow just about anyone to build their own body monitoring devices, reports Madgadget. The folks behind BITalino have made it easier to collect data from different body sensors, to process it, and to share it. The software, which previously required standalone computers to run, is now available in a cloudbased version. It makes it easy to go from assembling a kit to using the gathered data, as there’s no software to install or a computer to manage.

Moreover, BITalino is beginning to provide plugins for the software that are designed to process specific kinds of data in a proper way. One of the first releases is a heart rate variability package that implements guidelines from the Task Force of the European Society of Cardiology and the North American Society of Pacing Electrophysiology. All the gathered and processed data can be stored on Dropbox, Google Drive and other online cloud storage systems. There’s also an Android app that can be used to gather data, and work is underway to allow memory cards to be used to acquire the data.

The new study adds to evidence that the right algorithms might transform the Apple Watch from personal trainer to personal physician.

www.firstimpressionsmag.com

First Impressions

January 2018

15

PAIN MANAGEMENT

Pain Management Improved technology and delivery systems have made it easier for dentists to keep patients comfortable and calm

BY LAURA THILL

The dreaded needle! For most patients about to receive an anesthetic, it’s their biggest nightmare and the last thing dentists want is for their patients to be uneasy in the chair.

Contrary to what many patients believe, the needle isn’t the greatest source of their pain; the majority of pain comes from the anesthetic itself, according to experts.

Pain: A major concern For most patients, receiving an injection is the most “fear-inducing” aspect of a dental visit, says Stanley Malamed, D.D.S., Emeritus Professor of Dentistry, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA. In fact, it is estimated that some 30 to 40 million persons in the United States avoid seeking dental treatment because of their fear of pain and needles.

16

January 2018

First Impressions

www.firstimpressionsmag.com

Malamed – a consultant for St. Renatus – believes that “pain control is the most important aspect of dentistry, as most dental treatment cannot be performed without adequate pain control.”

Not only do most patients fear the pain associated with an injection, many dentists are equally frustrated by their inability to successfully – and consistently – manage their patients’ pain, Malamed points out. Making matters worse, some needle-phobic

a 27-gauge short needle is used. However, practicing dentists tend patients have been known to faint (syncopy) – the most common to favor the 30-gauge needle because it is the smallest size availmedical emergency in dentistry, he notes. This – together with able, he notes. Indeed, many dentists have a misperception that a concern that the use of a syringe and needle can lead to inadversmaller needle size is associated with less pain for the patient. “This tent needlesticks and potential transmission of such diseases as is absolutely wrong and, in some cases, dangerous,” he says.

Hepatitis C and HIV – have led some doctors to explore a needle“A 30-gauge needle is only available in short or extraless alternative. “Kovanaze – a nasal spray consisting of 3 percent short,” Woolson continues. “Extra-short needles are designed tetracaine and 0.05 percent oxymetazoline – effectively provides for use with PDL injections, while short needles are designed anesthesia to maxillary non-molar teeth via a nasal spray,” he exfor infiltrations. (Long needles are designed for block injections.) plains. “No needles are involved.

Some dentists use 30-gauge short needles for block injections, “Most dentists dislike administering palatal injections bebut that is ill-advised, he says. This particular needle is 25 mm cause, in their mind, they hurt,” Malamed continues. “The same long, he notes. If it is used for, say, an inferior alveolar nerve is the case for their patients. Offering a new technology that problock injection, and the dentist needs to advance the needle vides profound anesthesia without the need for injection should 15–20 mm into the tissue, “that leaves very little room for error be well received by both doctors and patients. Further, there is if the needle breaks. no anesthesia extra-orally, so the upper lip does not get numb or droop.” This is a “significant advantage in some esthetic dentistry procedures,” he adds, as it won’t impair the patient’s ability to eat, drink or speak.

In addition, the availability of a relaAt Septodont, needles and pain management can mix – as long as the needles tively new drug called OraVerse – a local are high quality and designed with optimal patient comfort in mind. First and anesthesia reversal agent introduced to foremost, needle sharpness is key, notes Matt Woolson, product manager, the market in 2008 – helps reduce the Septodont. In addition, the company offers the Septoject Evolution needle – a amount of time a patient is numb. uniquely designed needle featuring a beveled scalpel – and the Septoject XL, which features an oversized lumen or bore. “The Evolution needle is so sharp, Needle: Addressing misconceptions it is only indicated for infiltrations and PDL injections,” he says. “There is too While more dentists are incorporating much risk using it on block injections, where it could damage a nerve.”

Kovanaze in their practice, needle injections remain a common and efficient means for delivering anesthetics. By se“I met one dentist who used a 30-gauge extra-short needle lecting the right needle size, dentists can provide injections for an inferior alveolar nerve block injection,” Woolson recalls. safely and more comfortably, notes Matt Woolson, product “An extra-short needle is only 10 mm long. That means this manager, Septodont. However, sales reps may have to help dentist not only advanced the needle to the hub, but had to comclear up a few misconceptions for their dental customers. press the patient’s tissue enough to permit the needle to be in“Many dentists hate giving injections as much as their pajected even further. Imagine the discomfort for the patient!” And, tients hate getting them,” says Woolson. But that needn’t be the if the dentist inadvertently breaks a short or extra-short needle case. Features such as needle sharpness, length, bore size and during an inferior alveolar nerve block, he or she may need to quality all impact the injection delivery, he points out. “Most densurgically remove it. To do so would cause scarring on the patists don’t know what needle brand they use,” he notes. Yet, the tient’s neck, not to mention a lawsuit, he points out. manufacturing process and quality of materials can have a big “Years of clinical research shows there is no perceptual difimpact on the efficacy of the needle. ference between a 25-, 27- and 30-gauge needle when inserted Dental needles are typically available in three gauges into the oral tissues,” says Malamed. “Yet dentists persist in using (25-gauge, 27-gauge and 30-gauge), according to Woolson. The 30-gauge short and ultra-short needles for all injections, including smaller the needle gauge, the larger the needle size. In addition, the inferior alveolar nerve block.” In fact, over half of all needles sold the 25-gauge and 27-gauge needles are available in two lengths to dentists in the United States are 30-gauge, he points out. “I’d love (long and short), while the 30-gauge needle is available in short to see them use 27-gauge long and short needles, but after 43 years and extra-short. Dental schools encourage students to use a 25- or of teaching and preaching, I’m running short on hope in this regard.”

27-gauge needle, and most commonly a 25-gauge long needle and

Looking sharp

www.firstimpressionsmag.com

First Impressions

January 2018

17

PAIN MANAGEMENT

“ Offering a new technology that provides profound anesthesia without the need for injection should be well received by both doctors and patients.”

– Stanley Malamed, D.D.S.

Reaching out to customers Reps can initiate a discussion about pain management by asking a few probing questions: • “Doctor, have you ever had a patient faint during an injection?”

• “Do your patients ever ask you if you have to give them a shot in order to do a procedure? Do they ever confess that they hate getting shots, but once they are numb they’re okay? These patients are prime candidates for needleless nasal spray for their planned treatment involving maxillary non-molar teeth.”

The cost of new technology may be a factor to the dentist, but it shouldn’t be, says

Malamed. “I am perplexed at how a dentist can quibble over the cost of new technologies that enable him or her to provide better quality pain control, more easily, more comfortably and with increased safety. Yet they do. Yet these very same doctors will spend many thousands of dollars buying lasers, intraoral TV cameras and other truly expensive technology that, in many cases, cannot be used without the dentist first achieving effective pain control.

“To paraphrase the old Mastercard advertisements: What is it worth to be able to provide your patients with pain-free dentistry using, for example, a needleless technology, when the two most important items in a patient’s shopping list for a ‘good dentist’ are, ‘I don’t want to be hurt’ and ‘a painless injection?’ It is truly priceless.”

Buffered anesthetic For many patients, the worst part of a dental procedure is the initial injection of the anesthetic. A fear of the needle – together with their concern that the numbness might not last and they’ll experience great pain – presents a challenge for dentists, whose goal is to provide an optimal patient experience.

Indeed, a common misconception among patients is that the stick of the needle is the biggest source of pain when, in fact, the bulk of pain comes from the anesthetic itself. “Local anesthetic is very acidic, with a pH level as high, if not higher than that of citric acid,” says Ryan Vet, vice president of marketing, Anutra Medical. Consider getting injected with lemon juice, he points out. “No wonder it burns!”

One solution is the Anutra Local Anesthetic Delivery System, notes Vet. “By utilizing buffered anesthetic from the Anutra Local Anesthetic Delivery System, practitioners are able to inject local anesthetic at an acidity level that mirrors that of the patient’s body,” he continues. Some patients have even commented that they were unaware of receiving the shot, he adds. Additionally, whereas only twothirds of patients typically reach pulpal anesthesia after the first injection of anesthetic, with buffered anesthetic, “the majority of patients get numb the first time,” he says.

18

January 2018

First Impressions

www.firstimpressionsmag.com

“Utilizing buffered anesthetic helps the anesthetic take effect – on hard-to-numb patients as well as during nerve blocks – often in two minutes or less,” says Vet, providing dentists with as much as 15-20 minutes for each restorative procedure they perform. For dentists who perform as many as 20 or more cases each week, they may gain an extra hour or two in a typical day, he points out, offsetting the higher expense for dentists purchasing a premium anesthetic such as Anutra.

Buffered anesthetic is far more reliable than traditional anesthetic, says Vet. This means fewer bail-out shots.

Anutra is also more predictable, making it possible to schedule shorter appointment times and schedule more efficiently. Buffered anesthetic is more profound than traditional local anesthetic, allowing dentists to use less volume than they traditionally would have. Additionally, with the multi-dose Anutra Syringe, dentists are able to deliver the precise amount of anesthetic required, eliminating waste.

This means the dentist is no longer confined to a 1.8 mL carpule. Most importantly, Anutra helps ensure peace of mind for patients, making their experience in the chair a positive one.

Enhance your practice with Porter nitrous oxide systems and nasal masks.

Porter offers the widest selection of flush-mount and portable flowmeters in the industry.

In addition, Porter’s Silhouette Nasal Mask and breathing circuit features a patented low profile design for unobstructed access to the oral cavity.

Learn more and watch videos at www.porterinstrument.com/silhouette

Porter is your complete Nitrous Oxide resource

Porter Digital MDM Flowmeter

Matrx MDM Flowmeter Porter MXR Flowmeter

Porter Digital MXR-D Flowmeter

www. PorterInstrument.com/dental 215-723-4000

INTRODUCING

SpeedCEM Plus ®

Self-adhesive resin cement

A BIG

PLUS FOR ZIRCONIA THE PLUS FACTORS: + Excellent self-cure performance ideal for zirconia and metal-ceramics + User-friendly handling and easy clean-up

RECOMMENDED FOR

ZirCAD

The only ZIRCONIA esthetic enough to be called e.max!

+ Efficient process with just one component

For more call us atin1-800-533-6825 in the1-800-263-8182 U.S., 1-800-263-8182 Canada.

For more call information, us at 1-800-533-6825 the U.S., 1-800-263-8182 in Canada.

For moreinformation, information, call us at 1-800-533-6825 in the U.S., in in Canada. © 2018 2016 Ivoclar Vivadent, Inc.Ivoclar Ivoclar VivadentVivadent, and Ivoclar SpeedCEM are registered trademarks ofregistered Ivoclar Vivadent, Inc. of Ivoclar © 2016 Inc. Vivadent andZirCAD SpeedCEM trademarks Vivadent, of Inc.Ivoclar Vivadent, Inc. © Ivoclar Vivadent, Inc.Vivadent, Ivoclar IPS e.max, andare SpeedCEM are registered trademarks