FI October 19

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October 2019

Addressing Oral Cancer A rising death rate forces dentists to pay closer attention.

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FOR DENTAL SALES PROFESSIONALS

OCTOBER 2019

Addressing Oral Cancer A rising death rate forces dentists to pay closer attention.

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Publisher’s Note 3 Feet

Instrument Management Systems

A Good Impression

Conventional impression materials continue to prove their value.

A key process for efficiency, organization and safety

Going for the Gold

CBCT continues to change the dental landscape

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2019 OSAP Annual Conference Healthy Reps

Health news and notes

Setting Them Up For Success

A bad system will beat a good person every time

Quick Bytes

Technology News

Windshield Time

Automotive-related news

News Editor’s Note

Addressing Oral Cancer

To Repair or Replace Longtime service tech Thomas Guarino continues to do right by his dental customers.

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First Impressions

October 2018

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PUBLISHER’S NOTE

SCOTT ADAMS Editorial Staff Editor Laura Thill lthill@ sharemovingmedia.com

3 Feet Periodically I write about personal events. So please forgive me for this Publisher’s Note. Last month, my youngest son, Nicolas Adams, graduated from the University of North Georgia. There are a few reasons why I share this information: 1. I’m a proud father (Duh) 2. My days of college tuition are over (Yes!) 3. The real reason – Rodney Bullard, vice president of corporate social responsibility at Chick-fil-a Bullard was the keynote for the commencement, and his speech made me think of distributor reps and the space you work in. Bullard told a story of a little lady (Ms. Adams, no relation) who changed his life as a 6-year-old boy. In elementary school, Bullard wasn’t reading at grade level, so Ms. Adams volunteered to tutor him the summer between first and second grade. He said as a 6 year-old it felt like a life sentence spending his summer with Ms. Adams reading. What he realized later was that Ms. Adams had given up her summer as well, and made a difference in his life.

From this story, Bullard pivoted to the students and their ability to change what he called the 3 feet around them.

“We’re all superheroes within our own 3 feet,” he said. If you want to change the world, make an impact every day on your 3 feet. Think about the 3 feet that surround the dental distributor reps that read First Impressions Magazine each month. Think of the number of lives you touch. Think of the support and knowledge you bring your customers for new products, technology, and efficiency. In my opinion, your 3 feet are vital to our nation’s health.

Two final thoughts: Only you control your 3 feet, and thank you for everything you do daily! I am honored to be in an industry that saves and heals lives everyday.

Dedicated to the Industry, R. Scott Adams

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Managing Editor Graham Garrison ggarrison@ sharemovingmedia.com Publisher Scott Adams sadams@ sharemovingmedia.com Founder Brian Taylor btaylor@ sharemovingmedia.com Senior Director of Business Development Diana Partin dpartin@ 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 The Dental Facts 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 2019 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

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SALES FOCUS

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

There’s no denying, dental technology has rapidly digitized in recent

years. Still, many traditional technologies, such as conventional impressions, continue to play an important role in patient healthcare. Conventional impressions are still required for subgingival tooth preparations. In addition, impression materials can displace blood and saliva, whereas digital impression systems are not able to capture the margin when moisture or soft tissue blocks the tooth preparation. From gingival retraction pastes to compact intraoral syringes for efficient application of wash material, the technology behind conventional impressions is continually improving.

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

A history of precision Since reversible hydrocolloids were developed in the 1930s, enabling dentists

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First Impressions

to make impressions of undercuts, precision impression materials have become increasingly versatile. Soon after, dentists began using polysulfides and C-type silicones, although these materials were associated with shrinkage.

By 1965, ESPE – currently 3M Oral Care – had introduced polyether impression material as a single-step, medium viscosity impression material. Considered

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unique for its time, polyether impression material was known for its highly mechanical properties and excellent elastic recovery. And, there was virtually no concern about shrinkage. Dentists could depend on the material’s intrinsic hydrophilicity, and unique flow and setting behavior.

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

Soon after the invention of polyether impression materials, new silicone chemistries were introduced, which were

formulated with improved hydrophilicity. Vinyl polysiloxanes (including VPS/ PVS, additional silicones and A-silicones) have always been intrinsically hydrophobic, but the addition of a surfactant has improved hydrophilicity. Recent vinyl polysiloxanes are known to contain tailor-made cross linkers designed for high tensile strength, resulting in high tear resistance and high elastic recovery. These materials are commonly used with popular double-bite and one-step techniques.

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

stability. Alginate replacements are used to fabricate temporary restorations, as their smooth silicone surface can be easily trimmed. And because the impression has an unlimited shelf life, it can be used to remake temporary restorations when needed. These materials can be automatically mixed with hand dispensers or automatic mixing systems, eliminating mixing and processing errors.

Hand-mixed vs. automatic All impression materials must be mixed from at least two components – usually a base and catalyst paste. Most impressions are still performed with hand-mixed materials, although hand dispensers with

Starting a conversation For some dentists, if their current impression material has been doing the job, they may be reluctant to try a new product. However, by asking a few probing questions, distributor sales reps can help them find a solution best-suited to the needs of their practice. For instance: • “Doctor, what do you like/dislike about your current impression material? Is there something you would like to change?”

• “What percentage of impression retakes are necessary using your current impression material?”

• “How long do your impression appointments generally take?”

Alginates Developed in the late 1930s, soon after reversible hydrocolloids, alginates continue to be used for preliminary impressions. They generally are mixed by hand, since their material properties are only slightly improved with mixing devices. However, alginates provide poor surface detail reproduction and impressions must be cast within 15-30 minutes, since the impression shrinks as water evaporates from the alginate gel.

This makes alginate impressions poorly suited for the preparation of temporary restorations, since they cannot be stored and reused. That said, alginates have low tear resistance, which can sometimes be an advantage, as when taking an impression of a periodontally affected tooth or over-fixed orthodontic appliances. These cannot be reproduced with tear-resistant materials, since that particular material cannot be removed from the patient’s mouth.

As an alternative, alginate replacements were introduced as cost-effective VPS materials offering high-dimensional

From general dentists to orthodontists, prosthodontists and oral surgeons, dental professionals continue to rely on conventional impressions to create custom restorations, such as crowns, bridges and implants, as well as orthodontic appliances. dual-barrel cartridges have been available since 1983 and automatic mixing systems for foil bags since 1993.

Ergonomic and clinical considerations often prompt dental practices to upgrade to automatic mixing systems.

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

Sales reps should also engage their dental customers currently using a hand dispenser and cartridges in a discussion about automatic mixing systems. Are they aware of the potential time savings and reduced stress for assistants once they upgrade to an automatic system?

Over time, impression materials have proven their value, and they likely will continue to do so for years to come.

Equipped with the right solutions, dentists and their assistants are more likely to achieve the best possible results.

Editor’s note: First Impressions Magazine would like to thank 3M for its assistance with this article.

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Addressing Oral Cancer A rising death rate forces dentists to pay closer attention.

BY LAURA THILL

The death rate associated with oral cancer – a group of cancers that com-

prise about 85 percent of all head and neck cancers – is high, not because it is difficult to discover or diagnose, but because it routinely is discovered at a late stage, according to the Oral Cancer Foundation. Close to 53,000 people are expected to be diagnosed with oral cancer in 2019, and of those 53,000, only slightly more than half are expected to be alive in five years (https://oralcancerfoundation.org/facts/).

Oral cancer often is discovered late, not because dentists and doctors are errant, but because most people fail to see their dentist or doctor for regular checkups, notes Jason Genta, DDS, vice president of clinical affairs, DecisionOne Dental Partners, Schaumburg, Illinois.

“Unlike skin or other tissues that can be easily seen, the oral cavity is a compact, dark area,” he points out. “If something in the oral cavity does catch a patient’s attention, and he or she seeks advice from a dentist, it’s likely the issue has been developing for quite some time.”

Furthermore, it’s becoming increasingly common for patients to be diagnosed with oral cancer at a younger age.

“Traditionally, oral cancer was linked to people over the age of 40, often as a result of long-term alcohol and nicotine use,” says Genta. “People under 40 did not typically present with traditional risk factors.” But this has changed somewhat quickly. “Studies and research have linked this increase to the Human Papilloma Virus – specifically HPV 16 – which has been associated with several types of cancer that affect younger populations.”

Staying proactive In spite of the fact that there is no comprehensive oral cancer screening program in the United States, dentists can do their part to be proactive, notes Genta. Dentists need

“ If something in the oral cavity does catch a patient’s attention, and he or she seeks advice from a dentist, it’s likely the issue has been developing for quite some time.”

— Jason Genta, DDS, vice president of clinical affairs, DecisionOne Dental Partners, Schaumburg, Illinois

to spend as much time checking for signs of oral cancer as they do examining the teeth and periodontal tissue, he explains.

“Standard practice should include a visual and tactile oral cancer exam every six months on all adult patients,” he says. “The definition of an adult may vary, but because early detection is key to preventing this disease, I recommend screening patients

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ORAL CANCER Oral cancer detection and light-based screening Fluorescence-based oral cancer screening technology has been available to dentists since the VELscope was FDA-approved in 2006, according to Wayne Rees, vice president, VELscope. “The first systems were very large and utilized a metal halide light source and a handpiece that needed to be attached to the light source,” he explains. Not only was the system difficult to transport from one operatory to the next, it required a substantial warm-up time and at $7,000, the cost was prohibitive.

“Our new system uses LED light technology,” says Rees. “The VELscope Vx’s blue light excites natural fluorophores in mucosal tissues. In turn, the fluorophores emit their own light in shades of green, yellow and red. A

as young as 16 years. Using palpation, together with visual inspection under proper lighting, dentists can cover several areas, including the lymph nodes, neck and jaw, floor of the mouth, tongue, gingiva, hard and soft palate, and the back of the throat.

Dentists should be looking for any symmetry irregularities, bumps or lumps, or red inflamed areas that don’t appear to be the result of trauma, such as accidently biting one’s tongue.” With six-month oral cancer screenings, dentists have the greatest chance of catching abnormalities very early, he adds.

An adjunct to standard exams There’s no question, visual and tactile exams are considered the standard for screening oral cancer, according to Genta.

However, many dental practices – including his own – elect to perform light-based oral cancer screening as an adjunct.

“Light-based screening should be an adjunct – not an alternative – to visual and tactile screenings,” he states. “Having said

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proprietary filter makes fluorescence visualization possible by blocking reflected blue light and enhancing the contrast between normal and abnormal tissue.”

The new system is lightweight and portable, and it does not require a warmup period. In addition, dentists can attach an iPod Touch to the system, enabling them to capture images of the lesions, which can be stored in the patient chart or shared with a specialist or the patient. The price has come down as well, Rees adds. “The new system sells for $1695.00, making it affordable for every dentist.”

Light-based screening is noninvasive and does not require rinses or dyes, according to Rees. “There is no better service a practice can provide to their patients.”

“ Dentists today must educate patients that a dental exam is a crucial component to comprehensive healthcare.”

— Jason Genta, DDS, vice president of clinical affairs, DecisionOne Dental Partners, Schaumburg, Illinois

that, DecisionOne Dental Partners has light-based tools in all 28 of our offices.

Since early detection is key, using this tool as an adjunct to potentially catch a case early is a huge benefit to our patients.

“The only con to the patient is that sometimes there can be a false positive,” he continues. “Something that looks abnormal under the light may be a burn or traumatic lesion. This is why it is important for clinicians to understand the technology, have a proper follow-up protocol and refer patients for further testing when indicated. I think all dentists would rather err on the side of caution and have a false positive as opposed to missing a lesion they could potentially catch early.”

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Traditionally, patients have regarded their biannual dental checkups as an opportunity to have their teeth looked at.

It’s up to dentists to impress on patients that dentistry has assumed a much more holistic approach, according to Genta.

“Dentists today must educate patients that a dental exam is a crucial component to comprehensive healthcare,” he says. “It’s important to ensure patients understand both the severity and risk factors of oral cancer (drinking, smoking, HPV16), and then recommend cessation of those habits, as well as the HPV vaccine to those patients who could be at risk. This is an important part of our job as healthcare providers.”

ORAL CANCER Xerostomia

The most common toxicity associated with standard fractionated radiation therapy to the head and neck, xerostomia is defined as dry mouth resulting from reduced or absent saliva flow, according to the Oral Cancer Foundation. While it is not a disease, it may be a symptom of various medical conditions, a side effect of a radiation to the head and neck, or a side effect of a wide variety of medications.

Diagnosis of xerostomia may be based on evidence obtained from the patient’s history, an examination of the oral cavity and/or sialometry (a simple office procedure that measures the flow rate of saliva).

Acute xerostomia from radiation is due to an inflammatory reaction, while late xerostomia, which can occur up to one year after radiation therapy, results from fibrosis of the salivary gland and is usually permanent. Radiation causes changes in the serous secretory cells, resulting in a reduction in salivary output and increased viscosity of the saliva. A common early complaint following radiation therapy is thick or sticky saliva. The degree of

permanent xerostomia depends on the volume of salivary gland exposed to radiation and the radiation dose. When the total radiation dose exceeds 5,200 cGy, salivary flow is reduced, and little or no saliva is expressible from the salivary ducts. These changes are typically permanent.

Certain cancer chemotherapeutic drugs can also change the composition and flow of saliva, resulting in xerostomia, but these changes are usually temporary.

Xerostomia may also occur during graft-vs.-host disease.

When donor lymphocytes proliferate and infiltrate the recipient’s salivary glands and other tissues, changes can occur in a clinical pattern resembling those seen in Sjögren’s syndrome.

Patients experiencing xerostomia from radiation therapy or cancer chemotherapy are at particular risk of infections from normal oral flora. Oral ulcerations can become the nidus of invasive gram-positive and gramnegative infections, and opportunistic infections with fungal organisms such as Candida can occur.

Source: https://oralcancerfoundation.org/complications/xerostomia/.

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ORAL CANCER Oral Cancer Oral cancers are part of a group of cancers commonly referred to as head and neck cancers, according to the Oral Cancer Foundation. Of all head and neck cancers, they comprise about 85 percent of that category. (Brain cancer is a cancer category unto itself and is not included in the head and neck cancer group.)

Historically the death rate associated with this cancer is particularly high, not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development. Today, (2019) that statement is still true, as there is no comprehensive program in the United States to opportunistically screen for the disease. Another obstacle to early discovery is the advent HPV16, contributing more to the incidence rate of oral cancers, particularly in the posterior part of the mouth (the oropharynx, the tonsils, the base of tongue areas), which many times does not produce visible lesions or discolorations that have historically been the early warning signs of the disease process in the anterior (front) of the mouth.

Often oral cancer is only discovered when the cancer has metastasized to another location, most likely the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is caught in a localized intraoral area. Besides the metastasis, at these later stages, the primary tumor has had time to invade deep into local structures.

Oral cancer is particularly dangerous because in its early stages it may not be noticed by the patient, as it can frequently prosper without producing pain or symptoms they might readily recognize, and because it has a high risk of producing second, primary tumors. This means that patients who survive a first encounter with the disease have up to a 20-times higher risk of developing a second

cancer. This heightened risk factor can last for five to 10 years after the first occurrence. There are several types of oral cancers, but around 90 percent are squamous cell carcinomas. Though relatively rare, ACC and MEC cancers are highly deadly, as the depth of knowledge about them is far less than SCC. It is estimated that approximately $3.2 billion is spent in the United States each year on treatment of head and neck cancers. (2010 numbers).

After an informed public that is knowledgeable about the risk factors for oral cancer, the dental community is the first line of defense in early detection of the disease.

Including both generalists and specialists, there are over 100,000 dentists in the United States, each one seeing between eight and 15 patients per day. Including patients who come to a practice and see someone other than the dentist, such as the hygienist, the number of patient visits is significantly higher.

The American Dental Association states that 60 percent of the U.S. population sees a dentist every year. Just doing opportunistic cancer screenings of the existing patient population would yield tens of thousands of opportunities to catch oral cancer in its early stages.

After a definitive diagnosis has been made and the cancer has been staged, treatment may begin. Treatment of oral cancers is ideally a multidisciplinary approach involving the efforts of surgeons, radiation oncologists, chemotherapy oncologists, dental practitioners, nutritionists and rehabilitation and restorative specialists. The actual curative treatment modalities are usually surgery and radiation, with chemotherapy added to decrease the possibility of metastasis, to sensitize the malignant cells to radiation, or for those patients who have confirmed distant metastasis of the disease.

There are several types of oral cancers, but around 90 percent are squamous cell carcinomas.

Source: Https://oralcancerfoundation.org.

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RADIOLOGY

Going for the Gold CBCT continues to change the dental landscape

The last 20 years have seen major strides in dental technology, perhaps the most significant of which was the introduction of cone beam computed technology (CBCT) in the United States. As far as some doctors are concerned, the possibilities CBCT has opened continue to expand. Today, the technology is credited with having led to greater diagnostic accuracy, more precise implant placement, reduced chair times for patients and more.

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First Impressions reached out to a few doctors about the impact of CBCT and their ability to provide the best possible patient care. Here is what they have to say.

Heidi Kohltfarber, DDS, MS, PhD, oral and maxillofacial radiology, diplomate of the ABOMR, adjunct assistant professor, UNC-Chapel Hill, founder, Dental Radiology Diagnostics, consultant for Dentsply Sirona.

Thanks to CBCT, patients today spend less time in the dental chair, according to Heidi Kohltfarber, DDS, MS, PhD. Doctors can better educate their patients, creating a stronger doctor-patient bond and facilitating greater case acceptance. Not only are patients more involved and proactive in their overall healthcare, they can benefit from more accurate and innovative treatment options than ever before, she adds.

“CBCT was introduced into the dental field due to the need for low cost, low dose three-dimensional images for implant treatment planning purposes,” says Kohltfarber. “Clinicians were eager to improve the accuracy of implant placement and there was an obvious need to clearly visualize pertinent anatomy.

“The technology is based on a cone beam in which a dental X-ray source and reciprocating detector move in synchrony around the patient in a single rotation,” she explains. “It delivers multiple highresolution, multiplanar, reconstructed images, which provide a geometrically accurate representation of the patient’s anatomy in the axial, sagittal and coronal sections with a 1:1 measurement ratio of objects within the volumetric images.

“Cone beam CT was invented from a combination of three different technologies,” says Kohltfarber. “The original image intensifiers are similar to those used in cardiac imaging with fluoroscopy. It

employs an algorithm used for medical CT and is usually constructed and designed on a unit that is structurally similar in appearance and size to a dental panoramic X-ray machine. As such, it will fit into a dental office.”

First Impressions: How has CBCT led to greater efficiency?

Heidi Kohltfarber, DDS, MS, PhD, oral and maxillofacial radiology: Cone beam CT is an excellent modality, which has led to greater diagnostic accuracy, become a foundation for digital dentistry, and enhanced patient education. For example:

and efficiently (such as apical pathologies, periodontal bone loss, position and orientation of the teeth, visualization of the airway space and temporomandibular joints, as well as give a more accurate estimation of tooth prognosis.)

• Cone beam CT volumes provide clinicians with the ability to enhance patient care through surgical simulations that improve surgical treatment planning, surgical predications, fabrication of surgical stents and post-surgical follow-up. In fact, a very exciting

“ CBCT images can be used to produce surgical guides that are based on a clinician’s implant treatment plan. This has helped to decrease chair time during implant surgery, as well as decrease the chance of post-operative complications.”

– Heidi Kohltfarber, DDS, MS, PhD

• CBCT images can be used to produce surgical guides that are based on a clinician’s implant treatment plan. This has helped to decrease chair time during implant surgery, as well as decrease the chance of post-operative complications.

• It has multiple applications beyond implant dentistry, such as endodontics, periodontics, orthodontics, prosthodontics and craniofacial surgery.

• It has improved efficiency by allowing clinicians to visualize the dentition without the impediment of superimposition of structures, enabling them to diagnose in multiple areas more effectively

and emerging area is the use of cone beam CT volumes to develop 3D models, as well as 3D printed appliances and surgical guides.

First Impressions: How has CBCT impacted the role of dental professionals?

Kohltfarber: With CBCT, the entire dental team can be better involved in patients’ health and welfare.

• Dentists can diagnose patient problems more efficiently and accurately. They can provide more accurate implant placement, more accurate surgical and orthodontic results, and place same-day crowns.

• Dentists can diagnose limited airway spaces, which may cause obstructive sleep apnea; observe

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RADIOLOGY

and appropriately refer patients to their medical colleagues for vascular calcifications that may put patients at an increased risk for stroke; and visualize various pathologies while they are still treatable.

• Dental hygienists can more accurately visualize periodontal bone levels, areas of bone loss and radiographic calculus. Dental assistants can take diagnostic images much more quickly than traditional full-mouth series.

• Office managers can provide more efficient schedules to help improve overall patient care and satisfaction.

First Impressions: How will dental radiology continue to evolve?

Kohltfarber: The industry continues to research three-dimensional imaging and hopes to develop new technologies that will help make dentists more productive and efficient, as well as provide patients with more options for better dental care.

CBCT has given scientists the ability to observe a particular anatomic region with an accurate 3D representation, which can be segmented into a 3D model, rotated and overlaid with the same object from another time period. As such, they can easily evaluate everything from orthognathic surgery cases to orthodontic treat-

“ A patient’s visit to a dental office looks vastly different today versus five years ago. Thanks to CEREC and related technologies, patients are finding their crowns can be completed in one appointment, rather than having to live with a temporary crown for two or three weeks. With CBCT, patients can get a proper diagnosis at the first appointment instead of making multiple visits while we watch their tooth, waiting for the symptoms to worsen.”

– Keith R. VanBenthuysen, DMD, FAGD

First Impressions: When is it more appropriate for dentists to use twodimensional radiographs?

Kohltfarber: Cone beam CT is not a great imaging modality for caries diagnosis. Imaging artifacts around metallic restorations can lead to increased false positives. Therefore, traditional 2D radiographs, such as intraoral bitewings, should still be employed for the task of caries diagnosis. However, there is exciting research in the area of digital tomosynthesis currently being conducted at UNC-Chapel Hill, which may soon change the way that we view traditional bitewing radiographs.

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ment, periodontal bone loss, osteoarthritic changes, limited airways and craniofacial surgery cases over time. In addition, based on three-dimensional, segmented models, scientist have been able to 3D print bony scaffolds, infuse them with stem cells and regrow various anatomical regions, such as mandibular condyles. The ability to replace a diseased area with one that is anatomically correct for the patient could be phenomenal. Other imaging modalities, such as digital tomosynthesis, ultrasound and magnetic resonance imaging, are also being evaluated for their accuracy and efficacy in the field of dentistry. Digital dentistry is just the tip of the iceberg.

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Keith R. VanBenthuysen, DMD, FAGD, a Nashville, Tennessee-based practice owner and a consultant for Marquee Dental Partners.

Digital radiography has dramatically changed the dental landscape, says Keith R. VanBenthuysen, DMD, FAGD. But cone beam computed tomography has advanced the industry even further. “With digital radiography, we are able to share images in real-time online with our colleagues,” he points out. “CBCT has taken the industry beyond that, advancing our ability to see the anatomy. It has become an invaluable tool to support dental diagnostics.” In fact, many industry experts believe CBCT has emerged as the gold standard for imaging in the oral maxillofacial area, he adds.

First Impressions: How has CBCT led to greater efficiency?

Keith R. VanBenthuysen, DMD, FAGD: A patient’s visit to a dental office looks vastly different today versus five years ago.

Thanks to CEREC and related technologies, patients are finding their crowns can be completed in one appointment, rather than having to live with a temporary crown for two or three weeks. With CBCT, patients can get a proper diagnosis at the first appointment instead of making multiple visits while we watch their tooth, waiting for the symptoms to worsen.

First Impressions: How has CBCT impacted the role of dental professionals?

VanBenthuysen: It has done so in many ways: • Endodontists are better able to diagnose cracked teeth and vertical root fractures. They are in a better position to determine whether or not the tooth is restorable.

Additionally, CBCTs can assist in determining the number, shape and position of the canals.

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•O ral surgeons can better evaluate the anatomy surrounding third molars, perhaps avoiding injury to the IAN. They can look at potential implant sites and pre-plan implant surgeries. In conjunction with CEREC technologies and CBCT, surgeons can create surgical guides with extreme accuracy, thereby avoiding many of the previous pitfalls associated with implant surgery. Procedures can be streamlined and performed in a more timely manner.

• CBCT has provided better diagnostic imaging for doctors and hygienists, improved efficiency for dental assistants and has enabled office managers to communicate treatment recommendations more clearly with insurance companies.

First Impressions: When is it more appropriate for dentists to use twodimensional radiographs?

VanBenthuysen: According to the FDA, total radiation doses from 3D CBCT exams

are 96 percent lower than conventional CT exams; however they deliver more radiation than standard 2D radiography.

It is my opinion that CBCT should be reserved for use where 2D radiographs and other diagnostic tools prevent doctors from making an accurate diagnosis. 2D X-rays may be more appropriate for the diagnosis of caries, periodontal disease and most endodontic cases.

First Impressions : How will dental radiology continue to evolve?

VanBenthuysen: It is my absolute belief that CBCT will improve our visualization of the oral and maxillofacial complex.

In the future, I expect radiation exposure will be reduced and the images will further improve. We will be even better able to combine CBCT with other technologies to enhance our treatment capabilities and outcomes. CBCT, digital radiographs and intraoral scanners will continue to revolutionize the practice of dentistry by maximizing economy and accuracy, minimizing chair time and reducing patient visits.

CBCT continues to advance dental industry

Over the past number of years, cone beam computed technology (CBCT) has decreased in price, making it increasingly prevalent, according to Eric Tobler, DMD, regional president, Stonehaven Dental, part of Mortenson Dental Partners. In addition, the dosage of radiation had decreased significantly, he points out.

“In our practice CBCT is regularly referenced for review of impacted teeth, analysis of bone in edentulous areas and for endodontic diagnosis,” says Tobler. “This

is especially true for the diagnosis of maxillary molars, where CBCT may detect abscesses near the sinus or the presence of MB2, which may be difficult or impossible to detect with 2-D radiographs. CBCT can also be useful for organic orthodontic treatment, airway studies and the diagnosis of sinus conditions.” All that said, 2-D digital radiographs continue to be the preferred method for routine examinations and diagnosis of dental decay, he adds.

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First Impressions

October 2019

17

INFECTION CONTROL

Instrument Management Systems A key process for efficiency, organization and safety

BY DR. KATHERINE SCHRUBBE, RDH, BS, M.ED, PHD.

Editor’s note: Are your dental customers doing all they can to ensure a safe office environment?

Infection control expert Dr. Katherine Schrubbe shares a recipe for success.

What is the best way to guarantee that your favorite family cake recipe will

turn out? There are a few key basics that need to be considered. First, obtain all the required ingredients: flour, sugar and spices. Next, have the required equipment on hand: mixer, spatulas and pan. Lastly, follow the order of the recipe to ensure a consistent method for baking and serving. In short, be organized and have an efficient, standard process in place.

The same holds true for the management of instruments in a dental practice. Whether the practice is a larger

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group or a smaller private practice, the utilization of an instrument management system (IMS) that uses cassettes is key

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to ensuring organization, efficiency and patient safety. Although organization is not a natural strength for everyone, this management skill is critical in a healthcare environment to promote long-term benefits, such as increased efficiency, effectiveness, productivity and enhanced communication; having no specified systems in place can produce higher stress levels in the workplace.1

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BETTER EFFICIENCY MORE ORGANIZATION IMPROVED SAFETY

INFECTION CONTROL Regulatory safety and best practice According to OSHA’s Bloodborne Pathogens (BBP) Standard (29 CFR 1910.1030), dental practices must identify and use engineering controls. These are devices that isolate or remove the blood-borne pathogens hazard from the workplace.2 Engineering controls are products or devices that have been made or manufactured to help reduce the risk of injury to team members. A cassette is a container that holds instruments for specified procedures and is available in stainless steel, aluminum, plastic or resin material, which can withstand steam, chemical vapor and dry-heat sterilization.3 Cassettes fall under the category of engineering control safety devices, and when incorporated into practice, can reduce the risk of BBP exposure, especially during transporting and reprocessing of dental instruments. In fact, one study showed that 31 percent of sharps injuries occur when instruments are cleaned by hand.4 Team members assigned to reprocessing instruments in the sterilization area are constantly exposed to potential injuries from contaminated sharps, as well as chemicals; the use of cassettes reduces direct handling of contaminated instruments and keeps the instruments together through the entire process, from chairside to cleaning, sterilizing, storage and presentation to the next patient.3 Cassettes provide an extremely safe avenue because the team member never has to handle or hand-scrub the contaminated instruments. The cassette goes directly into a washer-disinfector or ultrasonic for cleaning.

When transporting contaminated sharps from the operatory to the sterilization area, OSHA states that immediately or as soon as possible after use, contaminated reusable sharps should be placed in appropriate containers

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until properly reprocessed. These containers must be puncture resistant, labeled or color-coded in accordance with this standard and leakproof on the sides and bottom.5 The CDC concurs on this aspect of practice and states team members should minimize handling of loose contaminated instruments during transport to the instrument processing area, as well as use work practice controls (e.g. carry instruments in a covered container) to minimize exposure potential.6 Thus, it is important to note that although cassettes reduce risk, they alone do not meet the criteria of the standard and should be placed on, or into, a secondary transport box, covered tray or container that meets OSHA’s standards for worker safety.

Efficiency is a win-win for all aspects of the practice. When the operatory is clutter-free and organized, the dentist and assistant are able to function more efficiently as a team. And when the team operates efficiently, a major benefit is increased productivity. The use of an IMS allows the smooth transfer of instruments between team members and permits them to devote more time to patient communication. When the team performs efficiently, they are also more likely to adhere to their scheduled appointment times, thereby helping the front-desk staff plan schedules accurately, without having to explain delays to patients.1 Cassettes also provide efficiency in the clinical setting by reducing the time needed for operatory set-up and clean-up,

Whether the practice is a larger group or a smaller private practice, the utilization of an instrument management system (IMS) that uses cassettes is key to ensuring organization, efficiency and patient safety.

Efficiency Being organized improves efficiency.

When an IMS with cassettes is used, all of the specified instruments for each procedure are readily available in the cassette. Patients perceive organization and its results. For some, the experience of visiting the dentist can be a source of anxiety, and the professionalism that organization conveys can help reduce this stress. The appearance of the dental operatory can significantly affect a patient’s experience, and an operatory that is clutter-free and organized will be more appealing to patients.1

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and facilitating a streamlined process during treatment. If cassettes are labeled by procedure in the storage area, the team member can easily select the type of cassette needed. While working, the cassette can be used on the tray to hold and keep instruments in order, reducing the messy tray problem for providers, as well as patients. As for clean-up, once treatment is complete, the instruments can be returned to their place in the cassette, and the cassette can be closed, locked and transported safely to the sterilization area.1,7 It can’t be overstated: Cassettes keep instruments contained and away from

INFECTION CONTROL team members, thereby saving time during the reprocessing steps. Practices should always follow CDC guidelines and ensure that all cassettes are wrapped or placed in peel-pouch packages with appropriate chemical indicators prior to sterilization.3,6 The use of cassettes can also maximize counter and storage space in the sterilization area, as they can be neatly stacked and stored more efficiently than trays.

The following graphic illustrates how and where the sterilization steps can be streamlined and time saved when cassettes are utilized.

Although it is an investment to implement an IMS, there are long-term benefits that provide numerous advantages, which can have a positive impact on cost containment and instrument life.

A few examples include: • Maintaining inventory effectively.

Instruments are already allocated by cassette, so the chance of something being misplaced is reduced, as incomplete set-ups would be apparent.

Also, having an organized system for instruments will help maintain the instrument stock and reorders when necessary, rather than at a critical point during a procedure, when the instrument is needed.

flexible material. This can prevent the scratching of surfaces and unnecessary bending, and help extend instrument life.

• Improve the sterilization process. When instrument cassettes are loaded correctly and adequately spaced, it allows for complete decontamination (in the case of liquid submersion) and temperature penetration (during thermocycling via an autoclave) to every area of the instruments.

The use of an IMS may reduce the possibility of overloading trays or containers during instrument processing and the subsequent loss of sterilization efficacy.8

Efficiency is a win-win for all aspects of the practice. When the operatory is clutter-free and organized, the dentist and assistant are able to function more efficiently as a team.

Instrument longevity It is common knowledge that dental instruments are costly for any practice setting, and controlling cost is a high priority.

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• Reducing instrument breakage. Accidental dropping of instruments can occur at any time. However, when instruments are encased in a cassette, they are better protected, substantially reducing breakages. In turn, there will be fewer reorders and less down time due to important instruments breaking at an inopportune time.

• Extending instrument life. Cassettes space items appropriately and generally consist of rails that are constructed of a soft and

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Just like having the cake turn out perfectly, an Instrument Management System and the use of cassettes provide the practice with the tools needed to ensure organization, efficiency and safety.

When an IMS is in place, team members can perform their duties without hesitation, indecision or question, knowing that the practice is committed to team safety and efficiency. And the enhanced organization is integral to growing a practice that has methodical systems of well-orchestrated routines – always ready for the next procedure, the next patient, and the next day.1

References 1. L ance K, Reil E, Norsted J. Office organization systems enhance practice efficiency and patient experience. Inside Dental Assisting, Vol 7;5, Sept/Oct 2011.

Available at https://www.aegisdentalnetwork.com/ida/2011/10/office-organization-systems. Accessed July 12, 2019.

2. U .S. Department of Labor. Occupational Safety and Health Administration. OSHA Bloodborne Pathogens fact sheet. Available at https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdf. Accessed July 12, 2019.

3. Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team. 5th ed. St. Louis: Mosby Elsevier; 2013; 128.

4. Younai FS, Murphy DC, Kotelchuck D. Occupational exposures to blood in a dental teaching environment: results of a ten-year surveillance study.

Journal of Dental Education May 2001, 65 (5) 436-448. Available at http://www.jdentaled.org/content/65/5/436. Accessed July 12, 2019.

5. U .S. Department of Labor. Occupational Safety and Health Administration. OSHA Bloodborne Pathogens Standard. Available at https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS. Accessed July 12, 2019.

6. C enters for Disease Control and Prevention. Guidelines for infection control in dental health-care settings – 2003. MMWR Recomm Rep 2003;52(RR-17):161. Available at https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030. Accessed July 12, 2019.

7. G ovoni M. Instrument management systems. RDH; April 1, 2012. Available at https://www.rdhmag.com/infection-control/sterilization/article/16405818/ instrument-management-systems. Accessed July 15, 2019.

8. D entalytec. Dental sterilization cassettes; a case study of the pros and cons. December 21, 2016. Available at https://www.dentalytec.com/en/dental-sterilization-cassettes-case-study-pros-cons/. Accessed July 15, 2019.

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.

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23

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IVOCLAR VIVADENT

Dental Zirconia and Keys for Clinical Success

BY SHASHIKANT SINGHAL, B.D.S., M.S., DIRECTOR OF PROFESSIONAL SERVICES, IVOCLAR VIVADENT, INC.

Dentists have increasingly requested zirconia as an alternative to

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

Figure 1

With recent advancements, a variety of zirconia materials (4Y-TZP, 5Y-TZP) has become available to meet dentists’ different functional and esthetic demands.

Differentiated by a number of factors – including composition, mechanical and optical properties – today’s new zirconia materials offer dentists and laboratories solutions that can be milled to full contour, and that demonstrate acceptable esthetics and translucency suitable for clinical situations where high mechanical stability, thin restoration walls and natural esthetics are essential.

What is dental zirconia?

Dental zirconia (ZrO2) is the oxide version of zirconium (Zr). Zirconium occurs in nature only as a mineral – mostly as zircon (ZrSiO4) – and is a soft, ductile, shiny-silvery metal, optically similar to aluminum foil.1,3 To produce dental zirconia, zircon is purified via complex production and purification processes and converted into synthetic zirconium precursors, which are finally transformed into ZrO2 through thermal and mechanical processes.

These are the only synthetic powder components used to make dental zirconia.1-3 Zirconia is polymorphic ceramic; depending on temperature and pressure, the same elements of the material exist in three different crystal structures (i.e., monoclinic (m); tetragonal (t); and cubic (c)). Pure monoclinic zirconia, the most stable phase, is present at room

Figure 2

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Table 1 – Dental Zirconia Classification 3Y-TZP Zirconia

4Y-TZP Zirconia

5Y-TZP Zirconia

4.5 – 6.0 wt percent Y2O3

6.0 – 8.0 wt percent Y2O3

9.05 – 10.0 wt percent Y2O3

~100 percent Tetragonal phase

~75 percent Tetragonal phase

~50 percent Tetragonal phase

0 percent Cubic phase

~25 percent Cubic phase

~50 percent Cubic phase

HIGHEST Mechanical Properties (~1,200 MPa)

HIGH Mechanical Properties (~850 MPa)

LOWEST Mechanical Properties (~650 MPa)

LOWEST Translucency

HIGHER Translucency

HIGHEST Translucency

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

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

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

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

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

The composition of zirconia material defines its mechanical and physical properties and hence clinical indications. The biaxial flexural strength of zirconia materials ranges from 650 MPa (5Y-TZP) to 1,200 MPa (3Y-TZPP). The higher the value, the stronger the material. In addition, the presence of polymorphic phases in zirconia material provides a phenomenon known as phase transformation toughening. It

causes the tetragonal crystals to change to monoclinic when a crack is introduced.

The monoclinic phase has a greater volume. This stops the crack from traveling through the material, basically pinching the crack shut (Figure 2) and, hence, further increases resistance to fracture. No phase transformation toughening can be observed in 5Y-TZP materials. Lastly, the translucency of 3Y-TZP is comparatively lower than 4Y-TZP and 5Y-TZP (most translucent), resulting in a clinical decision-making tree for clinical indications and cementation procedures.

Ensuring clinical success with today’s different zirconia materials As discussed earlier, the obvious disadvantage of new higher translucency and more esthetic ZrO2 materials is a reduction in the mechanical properties (e.g., lower fracture toughness, lower strength).

There is a growing interest in using zirconia for fabricating monolithic, full-contour restorations – particularly different generations that demonstrate new levels of optical and mechanical properties to meet dentists’ demands. The composition,

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IVOCLAR VIVADENT

mechanical properties, optical characteristics and processing of these new zirconias are different from previous generations of the high-strength material.4,5 Currently, newer generation cubic – 5Y-TZP (e.g., CubeX2) or hybrid – 4Y-TZP (e.g., IPS e.max® ZirCAD MT) zirconia materials are limited to single-unit restorations, or to three unit bridges. These zirconias exhibit improved translucency for esthetic full-contour (i.e., monolithic) restorations, but they demonstrate lower mechanical properties and a reduction in strength and fracture toughness compared to some other restorative materials.6,7 This may limit their use to certain indications, wall thicknesses and connector dimensions.

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

Figure 3

Figure 4

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Figure 5

Figure 6

technicians to consider the differences in properties among zirconia materials when selecting the ideal zirconia for a specific clinical indication.

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

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

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

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

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

2. After a try-in of the zirconia restoration in the patient’s mouth, it should be cleaned. Zirconia surfaces show a high affinity for phosphate groups,

and saliva and other body fluids contain various forms of phosphate (e.g., phospholipids) that may react irreversibly with the restorative surface and compromise bonding.

This also contraindicates the use of phosphoric acid on zirconia restorations. To clean zirconia restorative surfaces after try-in and create an optimum surface for adhesive bonding compared to other cleaning protocols, a unique product (Ivoclean®, Ivoclar Vivadent, Inc.) is indicated9, 10 (Figure 4).

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

The use of primers containing phosphate end groups, or cements containing MDP (10-methacryloyloxydecyl dihydrogen phosphate),

is recommended for achieving the best bonds to the tooth structure.

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

References 1. Volpato Maziero CA, D’Altoe Garbelotto LG, Celso Fredel M, Bondioli F. Application of zirconia in dentistry: biological, mechanical and optical considerations.

Advances in Ceramics-Electric and Magnetic Ceramics, Bioceramics, Ceramics and Environment. 2011:397-421.

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

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

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

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

2016 Apr;57:215-23.

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

7. Z hang F, Inokoshi M, Batuk M, et al. Strength, toughness and aging stability of highly-translucent Y-TZP ceramics for dental restorations. Dent Mater. 2016 Dec; 32(12):e327-e337.

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

9. K im DH, Son JS, Jeong SH, Kim YK, Kim KH, Kwon TY. Efficacy of various cleaning solutions on saliva-contaminated zirconia for improved resin bonding.

J Adv Prosthodont. 2015 Apr;7(2):85-92.

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

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

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Safest Dental Visit

TM

2019 OSAP Annual Conference • Companies engaged in infection control and safety products and services.

Participants left the conference with the ability to: • Describe current and emerging issues related to infection prevention and safety in oral healthcare settings.

• List new resources, tools and networks to optimize compliance.

• Identify important attributes to develop and enhance global leadership for the optimal delivery of infection prevention and safety.

The Organization for Safety, Asepsis and Prevention (OSAP) – a com-

munity of clinicians, educators, policy makers, consultants and industry representatives who advocate for the Safest Dental Visit™ – hosted its 2019 OSAP Annual Conference May 30 – June 2, 2019 at the Westin La Paloma Resort and Spa in Tuscan, Arizona. Billed as the premier patient infection and patient safety education networking event, the conference delivered the latest updates on evolving guidance and emerging infection prevention and safety issues.

Attendees had the opportunity to customize their experience through multiple topic tracks, gaining valuable information, resources and products designed to help them better address infection prevention and safety challenges, as well as meet new colleagues who share their interest in this critically important topic area.

In addition, OSAP partnered with Indian Health Services (IHS) to offer an IHS-only dental infection prevention and safety program May 29-30. The private event offered up to nine hours of CE credit. Preconference sessions were available for educators and consultants to earn additional CE credits.

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The 2019 OSAP Annual Conference was targeted to: • Educators.

• Infection control coordinators.

• Consultants and lecturers.

• Compliance officers of state dental boards.

• Risk managers.

• Policy makers.

• Sterilization technicians.

• Compliance officers of state dental boards.

• Hospitals and Federally Qualified Health Centers (FQHC) with dental clinics.

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Continuing dental education OSAP is an ADA Continuing Education Recognition Program (CERP) Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

To receive continuing education credit, participants were required to sign in at the conference, attend the sessions, record the assigned CE number for each lecture attended (note: CE verification numbers are announced at the end of each session), and complete the required evaluation forms. Attendees maintained their CE verification form as proof of participation in the educational programming.

For more information about the 2019 OSAP Annual Conference, email Office@ OSAP.org or call +1 (410) 571-0003 | US & Canada: +1 (800) 298-6727.

OSAP, DALE Foundation announce changes to Dental Infection Prevention and Control Certificate Program The Organization for Safety, Asepsis and Prevention (OSAP) healthcare personnel working in dental settings need to and the DALE Foundation have recently made some changes keep themselves and patients safe.” to the OSAP-DALE Foundation Dental Infection Prevention The certificate program is one component of a larger and Control Certificate Program to make the educational initiative of the OSAP, DANB and DALE Foundation colprogram more accessible for dental professionals. laboration that also includes online infection control When the program was first announced earlier this continuing education modules and two professional year, it included four steps and a variety of learning opdental infection control certification programs currently in tions. Based on industry feedback, the program has been updated and now the program is three steps, lower in cost, and entirely online.

“After speaking with several dental professionals, it became clear that streamlining the steps of the program would bring tremendous benefits,” says OSAP Executive Director Michelle Lee, CPC. “Access to high-quality infection control information is paramount and this three-step program delivers.”

The certificate program is in— Cynthia Durley, M.Ed., MBA, Executive Director of the tended for all healthcare professionals Dental Assisting National Board (DANB) and the DALE Foundation who implement infection prevention and control standards and guidelines in dental settings as well as educators, consultants, dental sales representatives, and state development. The impetus behind this initiative has been dental board and public health investigators and inspectors. the growing need for accurate and accessible dental in“Public protection is the driving force behind our fection control resources and valid third-party standardsorganizations’ work,” explains Cynthia Durley, M.Ed., based certification programs.

MBA, Executive Director of the Dental Assisting National To learn more about the educational certificate program Board (DANB) and the DALE Foundation. “By making or the forthcoming professional certifications, visit the these changes, we are increasing the accessibility of Dental Infection Control Education & Certification website critical infection prevention and control materials that all at dentalinfectioncontrol.org.

“ Public protection is the driving force behind our organizations’ work. By making these changes, we are increasing the accessibility of critical infection prevention and control materials that all healthcare personnel working in dental settings need to keep themselves and patients safe.”

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

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HEALTHY REPS

Health news and notes 30

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Eat better and skip the supplements

Current U.S. dietary guidelines recommend several healthy eating patterns, including Mediterranean and vegetarian diets, but they do not recommend routine supplement use to reduce the risk for cardiovascular disease or other chronic diseases

A new evidence review suggests that few nutritional supplements or dietary interventions offer any protection against cardiovascular disease or death, and some may actually cause harm.

Findings from a meta-analysis were published in Annals of Internal Medicine. Current U.S. dietary guidelines recommend several healthy eating patterns, including Mediterranean and vegetarian diets, but they do not recommend routine supplement use to reduce the risk for cardiovascular disease or other chronic diseases. Nonetheless, one out of two persons in the U.S. uses some form of supplements with the reported goal of improving overall health.

Evidence does indeed suggest that reduced salt intake is protective for all-cause mortality in participants with normal blood pressure, and that omega-3, long-chain fatty acids are protective for myocardial infarction and coronary heart disease. And yes, folic acid shows some protective benefit for stroke. BUT combined calcium plus vitamin D intake may increase the risk for stroke. Other supplements, such as multivitamins, selenium, vitamin A, vitamin B6, vitamin C, vitamin E, vitamin D alone, calcium alone, folic acid, and iron, or such dietary interventions as the Mediterranean diet, reduced saturated fat intake, modified fat intake, reduced dietary fat intake, and increased intake of fish oil supplements, do NOT seem to have significant effect on mortality or cardiovascular outcomes.

Truth or consequences You might assume that well-accepted medical advice (e.g., fish oil reduces risk of heart disease) is supported by mounds of scientific research. Not so, according to an article in The New York Times. Researchers recently discovered that nearly 400 routine practices were flatly contradicted by studies published in leading journals. Following are just 5 true things that contradict conventional “wisdom:�

1) Peanut allergies occur whether or not a child is exposed to peanuts before age three; 2) fish oil does NOT reduce the risk of heart disease;

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HEALTHY REPS 3) testosterone treatment does NOT help older men retain their memory; 4) if a pregnant woman’s water breaks prematurely, the baby does NOT have to be delivered immediately; and 5) to protect against asthma attacks, it will NOT help to keep your house free of dust mites, mice and cockroaches.

Go fish The U.S. Food and Drug Administration released revised advice regarding the consumption of fish, The guidelines, which provide advice for people in the U.S. 2 years of age and older, recommend that adults eat at least 8 ounces of seafood per week based on a 2,000-calorie diet.

They also emphasize that seafood has many nutrients, several of which have important roles in growth and development during pregnancy and early childhood. The revisions are designed to help consumers who should limit their exposure to mercury choose from the many types of fish that are lower in mercury, including salmon, shrimp, pollock, canned light tuna, tilapia, catfish and cod. It is important to note that women who might become pregnant, or who are pregnant or breastfeeding – along with young children – should avoid the few types of commercial fish with the highest levels of mercury listed on the FDA’s chart.

To view the guidelines, go to www.fda.gov/ food/consumers/advice-about-eating-fish

Acne drug and pregnancy The acne drug isotretinoin – formerly sold as Accutane – is known to cause miscarriages and birth defects. Yet a recent study published in JAMA Network finds that many women on the drug still become pregnant. Looking through the FDA’s adverse event reporting system, researchers found that between 1997 and 2017, more than 6,700 women became pregnant while taking isotretinoin, and some 11% of these pregnancies

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ended in miscarriages. The year with the highest number of pregnancies – 768 – was 2006. That same year, the FDA mandated a program known an iPledge to make women aware of the drug’s risks and require them to take contraceptives or vow abstinence. The rate of women on isotretinoin getting pregnant then dropped by more than half by 2010, although other factors – including the use of IUDs and other long-term contraceptives – could have contributed to the dip in pregnancies.

Who should use testosterone replacement therapy Many people can benefit from testosterone replacement therapy, according to experts at MD Anderson Cancer Center.

They include people who have had a serious medical treatment like chemotherapy or radiation, or who have injured a testicle. But taking testosterone to solve problems with fatigue, low energy or sinking sex drive without a full check-up can disguise the real causes of these symptoms. Testosterone should be checked at least twice using a blood test, says Conor Best, M.D., assistant professor in Endocrine Neoplasia and Hormonal Disorders at MD Anderson Cancer Center.

Both tests should be done in the morning between 7 a.m. and 10 a.m. If the tests show a low level, patients should discuss the possible causes with their doctor before deciding if testosterone replacement therapy is right for them. Diabetes and obesity, as well as increasing age, can lead to low testosterone. But if there’s no clear cause for low testosterone, working on diet and increasing exercise can often be the answer.

From gloom to gratitude A positive outlook can lead to less anxiety and stress, according to a new study of caregivers, as reported by NPR. Here are

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eight skills to help cope with stress: 1) identify one positive event each day; 2) tell someone about that positive event; 3) start a daily gratitude journal, identifying even the little things for which you’re grateful; 4) identify a personal strength and note how you’ve exercised it recently; 5) set a daily goal and track your progress; 6) practice “positive reappraisal,” which means reframing unpleasant events in a more positive light (e.g., turn stop-and-go traffic into a moment to savor the stillness); 7) do something nice for someone every day; 8) pay attention to the present moment (try a 10-minute breathing exercise).

Sleep regularly Failure to stick to a regular bedtime and wakeup schedule – and getting different amounts of sleep each night – can put a person at higher risk for obesity, high cholesterol, hypertension, high blood sugar and other metabolic disorders, according to a study funded by the National Institutes of Health and published in Diabetes Care. In fact, for every hour of variability in time to bed and time asleep, a person may have up to a 27% greater chance of experiencing a metabolic abnormality. “Many previous studies have shown the link between insufficient sleep and higher risk of obesity, diabetes, and other metabolic disorders,” said study author Tianyi Huang, Sc.D., epidemiologist of the Channing Division of Network Medicine at Brigham and Women’s Hospital, Boston. “But we didn’t know much about the impact of irregular sleep, high day-to-day variability in sleep duration and timing. Our research shows that, even after considering the amount of sleep a person gets and other lifestyle factors, every one-hour night-to-night difference in the time to bed or the duration of a night’s sleep multiplies the adverse metabolic effect.”

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MAKE A GOOD IMPRESSION With advanced video scanning technology and the smallest wand on the market providing better ergonomics and patient comfort, the Midmark Mobile True Definition™ Scanner can help you create consistently accurate visual impressions more affordably.

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Comparison to examples of other intraoral scanner wand sizes

Dentists can purchase a new Midmark Mobile True Definition Scanner and get the first year of data free. Does your Dentist already have a True Definition Scanner? They can add another mobile scanner to their True Definition family and get the first year of data free PLUS either free training or a $1,000 rebate.

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Dentists can receive a $250 rebate when they purchase any Preva Intraoral X-Ray. Offer ends December 31, 2019.

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SERVICE TECH PROFILE

To Repair or Replace Longtime service tech Thomas Guarino continues to do right by his dental customers.

Years before it crossed his mind to join the dental industry, Thomas Gua-

rino worked full time as a plumber. After taking on weekend gigs installing new dental equipment, however, his interest piqued. Then, 37 years ago, he received a full-time offer to install and repair dental equipment. “I immediately switched careers and have loved it ever since,” he says. In 1995, he joined Henry Schein Dental and continues to work as an equipment service technician, servicing the company’s dental customers throughout New York City.

Despite the evolution in dental technology since Guarino joined the industry, and the impact these advances have had on both equipment service technicians and field sales representatives, he is convinced the relationship between service techs and sales reps has remained much the same over the years. “Our relationship has always been grounded in a team mentality,” he says. It’s important for the two to maintain open lines of communication, especially since it’s rare that they encounter one another at their customers’ dental office, he points out. “We occasionally meet when new equipment is being installed to ensure it runs smoothly, or if there is a warranty issue on new equipment,” he explains. For the most part, though, service techs and sales reps are like ships passing in the night, he notes.

Consistent communication helps them stay on top of – and immediately address – their dentists’ concerns.

“Sometimes an account will call for the sales rep when actually a service tech is needed,” says Guarino. “In these cases, the sales rep will reach out to me, and I’ll follow up with our customer to schedule a service call. It’s always a team effort.”

Total trust It is said that dentists and their staff have a great deal of trust in their service

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advise them to repair or replace their equipment,” he says. “This bond is very valuable to the dentists, because their time is money.” And trust is a two-way street, he adds. “It helps us maintain our reputation as a reliable source.”

Service technicians certainly have their share of challenges, notes Guarino.

“For me, the greatest challenge is when I recommend that a practice replace a piece of equipment, and then an issue arises with the new equipment,” he says.

“This can be frustrating for everyone, especially when the issue requires a few service calls to address it. In these cases, I work with the manufacturer rep and his or her technical support person to ensure all issues are resolved.”

Challenges aside, Guarino finds his work to be very rewarding. “The praise I receive when I repair equipment that was causing the office to cancel appointments

“ The praise I receive when I repair equipment that was causing the office to cancel appointments is very special.”

— Thomas Guarino, equipment service technician, Henry Schein Dental technicians. In Guarino’s experience, this is very true. When the service tech recommends a piece of equipment can be repaired, they believe it. If the service tech says it is time to replace it, they believe that, too. Through the years he has worked hard to earn the complete trust of dentists and staff in every office he services. “I agree, the dentists I work with have a great deal of trust in my recommendations, whether I

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is very special,” he says, particularly when the dentist believed it was necessary to replace the broken equipment. And, thanks to continual advances in dental technology, his job will only get better, he points out. “Dental technology is always evolving, and mostly for the better,” he says. “It’s great to know I’ll be able to implement this new technology, which will help both our dental customers and their patients.”

BY LISA EARLE MCLEOD

Setting Them Up For Success A bad system will beat a good person every time

The waitress was late with the food. She looked frazzled and frustrated.

After she rushed off, we discovered the salad we requested with dressing on the side was doused in ranch.

Clearly, she wasn’t a good server. Or was she?

Edwards Deming said, “A bad system will beat a good person every time.”

I’ll take it step further, a bad system will chip away at your soul. Bad systems can turn even the most enthusiastic workers into frustrated, poor performers.

Paying the price for systemic failures Let’s go back to our waitress. The food was late because the kitchen was short staffed that day. Our server had noted salad dressing on the side in the order system. But the salad was mixed before they got to the expo station. The food runner saw dressing on the side, so he added another container of ranch to our plate. As for being frazzled, wouldn’t you be if half your orders were late, and customers were complaining about dressing?

If you’ve ever waited tables, you’ve no doubt experienced this for yourself.

The front line often pays the price for systemic failures.

As you look at your own organization, be it your workplace or your home, ask yourself, are your systems set up

to help people be their best, or do they create obstacles?

As a consultant, I see organizations try to solve problems by training employees or trying to get better employees. In many cases the issue is the system.

Recently, we were working with an organization where customer callbacks were a problem. A few employees were great at calling clients backs. But, more often than not, when customers called in with problems, the employees would promise to look into it, and fail to call back. Further investigation revealed that employees were making notes with the

LEADERSHIP

intent of getting back to customers. Yet as the day wore on, and the tasks piled up, they never circled back. After it sat for a few days, the employees either forgot about it, or were too embarrassed to call back.

The leadership team assumed it was a training and accountability issue. If the top performers could do it, clearly something must be wrong with everyone else.

After watching the team for an afternoon, I saw the problem. The top performers had created workarounds to ensure they never lost track of client issues. One woman put post its across her wall, another kept his client to do’s on a yellow pad. There was no systemic way for people to log notes, and have them pop back up until they were handled.

It’s easy to say people should create their own systems, but individual systems can’t scale.

One of my friends used to keep a birthday daybook. She was great about sending everyone a nice note on their special day. In terms of birthdays, she was a top performer. I always felt guilty not being that kind of friend.

Now, thanks to Facebook reminders, my good intentions can scale. Mediocre me is now a top performer in the birthday category.

If you want your team to excel at scale, look at your systems. Whether it’s dressing on the side, scheduling patient appointments, or how you handle inventory, ask yourself, is my system setting my team up for success?

A bad system will beat a good person. A great system will help all the good people be great.

About the author Lisa Earle McLeod is a sought after keynote speaker who has rocked the house everywhere from Apple to Peterbilt Trucking. McLeod is known for her cutting edge ideas, practical techniques, and inspirational humor. She is the author of 4 bestselling books, in 4 genres: leadership, sales, personal development and a collection of humor essays. For more information, visit www.mcleodandmore.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.

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E-commerce chase scene Microsoft continues its competitive race against Amazon in the retail space, reports Modern Retail. In early August, Microsoft announced that it purchased marketing technology platform PromoteIQ for an undisclosed amount of money. The acquisition, though small, is the latest in Microsoft’s attempts to level the playing field with Amazon, according to the magazine. Over the last few years Microsoft has garnered individual partnerships with retailers, which has laid the groundwork for marketers to see it as a

potential alternative to Amazon. Still, the company has a ways to go: Amazon has a solid leg up on both advertising (which brought in $3 billion in the second quarter) and cloud storage (which hit $8.38 billion in Q2 of this year). Adding PromoteIQ – whose clients include Overstock. com, Office Depot and Kohl’s – indicates that Microsoft is strategizing about how to expand and undercut the competition.

High bar for the next iPhone Samsung unveiled its new Note 10 and Note 10+ with a nearly framefree screen, four cameras on the back, in-screen fingerprint scanner, reverse charging and a 5G option, reports CNET. If these features are starting to sound familiar, it’s probably because they reflect many of the features rumored to be coming to the next iPhone, though in some cases (like 5G and 3D camera) not for at least another year, reports the magazine. Fancy screens and 5G don’t necessarily guarantee a great phone; there’s also the ecosystem to consider and the under-the-hood performance. But as far as specs go, there’s no denying Samsung has set the bar high for Apple.

A friendly reminder Google was preparing to unveil a new feature for its Assistant software that lets people send reminders to friends and family on their phones or Google Home devices, according to CNET. Here’s how the update (called “assignable reminders”) works: You trigger the Google Assistant (Google’s rival to Amazon’s Alexa and Apple’s Siri) by saying “Hey Google.”

Then you add a command. For example, tell the software to remind your spouse to take out the trash at 6 p.m. That person will get a reminder on their phone, Google Home smart speaker or a smart display that works with the Assistant. You can send reminders only to people who are listed as family in your Google account

or are linked and voice-matched to the same Google Home device. You can also set a reminder based on someone’s location. For example, if you want a friend to pick up something at the grocery store, you can set a reminder to pop up when they get to the building.

Goodies for Chromebook users Chromebook owners can look forward to four new features soon, reports Computerworld: 1) Virtual Desks, which lets you maintain separate work areas for separate projects; 2) simple sharing between devices signed into the same Google account (e.g., Android phones, other

Most annoying was the fact that each advertisement was displayed in fullscreen mode, forcing the user to watch the entire thing before being able to exit the screen or return to the app. The adware-laden applications included Magic Camera: Make Magical Photos, Blur Photo Editor, Background Replacement, Find the difference: smart detective, and Color House2019.

Keep intruders out!

What if you could plug in a box and instantly protect yourself and your family from online advertisers, big tech companies, ISPs and criminals? That’s

Google eradicated 85 Android apps from the Google Play Store this summer after researchers found they were adware posing as legitimate software, reports ZDNet. The apps reportedly masqueraded as photography utilities and games to lure Android handset users to download them.

Chromebooks, even Windows, Mac or Linux systems); 3) easier account management for all your Google accounts; and 4) smarter media controls.

Super annoying Google eradicated 85 Android apps from the Google Play Store this summer after researchers found they were adware posing as legitimate software, reports ZDNet. The apps reportedly masqueraded as photography utilities and games to lure Android handset users to download them. But once installed, they would push advertisement after advertisement.

exactly what the Winston Privacy Filter is designed to do, according to Digital Trends. The device encrypts your entire Internet activity, according to Winston CEO Richard Stokes, adding, “It scrambles it up with all the other Winstons out there, and then it’s putting into play various technology solutions, both at the network and application layer, to disable things like cookie tracking and browser fingerprinting.” The idea is that you plug your Internet connection into this unobtrusive box, plug your router into the other end, and every device on your home network is protected.

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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.

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Scooters, bikes and pedestrians We’ve all seen the increase in bicycle traffic – and now motorized scooters – on busy streets. It’s no surprise, then, that U.S. pedestrian and bicyclist deaths rose in 2018 while overall traffic deaths fell 1% in 2018, to 36,750, reports the National Highway Traffic Safety Administration (NHTSA). The auto safety agency said it did not know the cause of the overall decline but has

Most fatal bicyclist crashes involving motor vehicles occur midblock, while cyclists in protected bike lanes in the study collided with vehicles most often at intersections or junctions with driveways and alleys.

U.S. traffic death figures but has found challenges in getting an accurate picture of all distracted crashes because of the unwillingness of individuals to acknowledge they were distracted.

Protected bike lanes: Do they really protect?

said a dramatic increase in traffic deaths in 2016 was the result of more people killed on foot, bicycle or motorcycle. Pedestrian deaths accounted for 16% of all U.S traffic deaths in 2017, up from 12% in 2009. The agency has been investigating the role of distracted drivers in overall

Bike lanes separated from the roadway by physical barriers make cyclists feel safer and encourage more people to ride.

But a study by the Insurance Institute for Highway Safety shows that protected bike lanes vary in terms of injury risk. Factors such as the number of driveways or alleys intersecting the lanes and whether the lanes are one- or two-direction affect the likelihood of a crash or fall. Compared with a major road with no bike infrastructure, the risk of a crash or fall was much lower on two-way protected bike lanes on bridges or raised from the roadway – for example, within greenways. In contrast, the risk of a crash or fall on a two-way protected bike lane at street level was much higher than that of a major road. One-way protected bike lanes differed little from major roads in terms of injury risk. That said, the types of bicyclist crashes seen in street-level protected lanes weren’t the type that are typically most severe. Most fatal bicyclist crashes involving motor vehicles occur midblock, while cyclists in protected bike lanes in the study collided with vehicles most often at intersections or junctions with driveways and alleys. In such cases, vehicles are usually turning and traveling slowly.

Knee airbags Airbags save lives. More airbags, one might assume, would provide even greater protection. But a recent study by the

Insurance Institute for Highway Safety shows that one increasingly common type of airbag – the knee airbag – has a negligible effect on injury risk. Knee airbags usually deploy from the lower dashboard and are intended to distribute impact forces to reduce leg injuries. They may also help reduce forces on an occupant’s chest and abdomen by controlling lower body movement. In an analysis of real-world crashes, knee airbags reduced overall injury risk by half a percentage point, from 7.9 percent to 7.4 percent, but this result wasn’t statistically significant. That said, it is possible that knee airbags would help unbelted occupants in real-world crashes.

But the hope is, there aren’t many unbelted occupants on today’s roads.

Is flood damage insured?

Floods are the most common natural disasters in the U.S. Does your car insurance cover flood damage? Yes, but you will need comprehensive auto coverage if you want your insurance company to pay you for damage to your flooded vehicle, according to an article in Motor Trend.

Insure.com reports that the average rate for comprehensive coverage is $189 per year, which you’ll pay in addition to collision, which averages $523. If you don’t have comprehensive coverage and your car gets flooded, you’re likely out of luck.

Home insurance doesn’t cover flood damage, and even if you have a flood insurance policy tacked on, it will only cover damage to personal belongings in your car. There is one recourse, though. In the event of a natural disaster, you may be eligible for assistance from the Federal Emergency Management Agency (FEMA) in the form of a low-cost loan.

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NEWS

Industry News Burkhart Dental Supply hires Troy Stout as equipment specialist Tacoma-based Burkhart Dental Supply announced the hiring of Troy Stout as an equipment specialist in its Salt Lake City office. Stout has over 21 years of experience in the dental industry. He previously worked for Burkhart as a branch manager in Salt Lake and most recently was a reTroy Stout gional manager for another distributor in Salt Lake. He is also currently serving as Mayor of Alpine City, Utah. Stout graduated from the University of Utah with a bachelor of science degree in political science.

Henry Schein awards 4th annual Henry Schein Cares Medal in the Dental Category Henry Schein Inc (Melville, NY) awarded its fourth annual Henry Schein Cares Medal in the Dental category, recognizing three nonprofit organizations and naming United Cerebral Palsy Association of the Rochester Area (CP Rochester) (Rochester, NY) as “Best In Class.” The Henry Schein Cares Medal recognizes organizations that demonstrate excellence in expanding access to care for the underserved. CP Rochester was recognized for its commitment to serving the healthcare needs of people with developmental, intellectual, and acquired disabilities, and their families, living in Monroe County, NY, and for its Family Dental Center (FDC) in particular. CP Rochester opened the FDC in 2008 after determining

From left to right: Mary Walsh Boatfield, President & CEO, CP Rochester; Darrell Whitbeck, COO; Dawn D’Aversa, Director of Outpatient Clinical Services; Diane Kozar, VP of Clinic Services.

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that people with special needs in their area had limited access to oral health care for a number of reasons, whether a lack of accessible facilities or resources to train dental professionals to care for special needs patients. The FDC offers fully accessible facilities and dental operatories, and is staffed by specially trained personnel ready to address each patient’s unique needs. An independent panel of 15 judges selected CP Rochester as this year’s “Best In Class” medalist from a field that included fellow medalists La Maestra Family Clinic (San Diego) and Community Healthcare Network (New York). Each medalist receives a $10,000 cash award from the Henry Schein Cares Foundation.

Henry Schein acquires majority interest in Cliniclands Henry Schein Inc (Melville, NY) acquired a majority equity stake in Cliniclands (Trelleborg, Sweden), an innovative distributor serving dental practices throughout Sweden, Denmark, and Norway. Cliniclands represents the first presence of Henry Schein Dental in Scandinavia and offers a wide range of dental consumables, implants, prosthetic and orthodontic solutions as well as small and office equipment. For the 12 months ended March 31, 2019, Cliniclands had sales of approximately $9.5 million.

Cliniclands’ founders – Falk Andersson, CEO; Niklas Schori, COO; and Daniel Skoglund, head of sales – will continue to lead the business and own the remaining equity stake in Cliniclands, which Henry Schein may acquire under various options after the next three and five years. Financial terms were not disclosed.

With the addition of Cliniclands, Henry Schein now has operations in 32 countries around the world.

“Cliniclands is a rapidly growing, successful company built upon a valuable business model,” said Stanley M. Bergman, Chairman of the Board and Chief Executive Officer of Henry Schein. “We are delighted to partner with the co-founders and the entire Cliniclands team. Our two companies have a shared commitment to the use of advanced technology to help our customers run successful, profitable businesses. We expect to achieve meaningful operating synergies and category expansion while expediting the delivery of products to Scandinavian dental customers.”

“We are especially excited to partner with Henry Schein and work together to bring new services and solutions to the Scandinavian dental community,” said Falk Andersson. “Our partnership with Henry Schein represents a new chapter for our customers,

who will continue to receive the high quality service upon which they’ve come to rely, but with the added benefit of accessing a network of expert advisors with an in-depth knowledge of clinical businesses and a dedication of helping practitioners grow their dental practices.”

Midmark acquires True Definition Scanner from 3M Midmark Corp (Dayton, OH) acquired the True Definition Intraoral scanner platform from 3M (St. Paul, MN). According to the company, the Midmark Mobile True Definition Scanner uses technology “similar to the motion capture effects of Hollywood, making it not only incredibly accurate but also easy to use.” It is the first mobile intraoral scanner that operates solely on a tablet and features the smallest wand on the market. Midmark plans to further enhance the technology in the future. Upon purchase of the True Definition Scanner and affordable data plan, dentists will gain access to unlimited scans, crown and bridge restorations, connections to their lab of choice and third-party providers, plus much more. Midmark is working hard to ensure a seamless transition for more than 1,000 current customers of True Definition in the U.S. and Canada. Customers will continue to have access to their scans and will enjoy all the same services and support they expect from True Definition.

Four groups endorse AAP-AAPD dental sedation guidelines for children Four health organizations have added their endorsements to recent guidance from the AAP and American Academy of

Pediatric Dentistry (AAPD) that aims to improve the safety of pediatric patients undergoing dental sedation. The American Society of Anesthesiologists, Society for Pediatric Anesthesia, American Society of Dentist Anesthesiologists, and Society for Pediatric Sedation issued a statement supporting a joint AAP-AAPD clinical report, which recommends at least two individuals with specific training and credentials should be present with a pediatric patient receiving deep sedation/general anesthesia for dental treatment.

Global dental implants market to reach to $721.0M by 2024 A new report from Zion Market Research shows that the global dental implants market was valued at approximately $5.08 billion in 2017 and is expected to generate revenue of around $7.97 billion by end of 2024, growing at a CAGR of around 6.63% between 2018 and 2024. The “Dental Clinics” segment holds over half the market share in terms of revenue.

The report says that, “Moving forward, this segment is likely to receive a considerable boost from developing countries of the world due to increasing demand for private clinics.” Regionally, Europe is anticipated to lead the market throughout the forecast period. The report authors say that the geriatric population is the most profitable market for companies in the dental implants market. Additionally, endosteal implants are expected to lead the market with nearly 75% of the market share through 2024. Subperiosteal implants, which are based on CT scans of a patient’s jaw and custom made, will also be growing in demand.

New Products Ivoclar Vivadent announces the new 3s PowerCure System Ivoclar Vivadent (Amherst, NY) announced its 3s Powercure System. The company says the new 3s (three second) PowerCure System can help dentists reduce the treatment time for the incremental layering technique by more than half, while achieving the same esthetics and function of traditional 2mm layered composites. The 3s PowerCure System is comprised of products that are optimally coordinated for direct restorative procedures enabling esthetic, high-quality posterior restorations to be produced with extreme efficiency.

The system includes Adhese Universal (singlecomponent adhesive), Bluephase PowerCure (intelligent, high-performance

LED curing light), and Tetric PowerFill and Tetric PowerFlow (sculptable and flowable composites which can be placed in increments up to 4 mm). When light-cured from the occlusal surface with Bluephase PowerCure, the adhesive will polymerize in 3 seconds and each 4 mm layer of composite can be cured in 3 seconds, according to the company. The open system’s adhesive and composites are compatible with other curing lights when cured according to their instructions for use. The Bluephase PowerCure LED light has a choice of four different levels of light intensity, making it compatible with all other materials.

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NEWS

Benco Dental New Appointees Phil Barnes – Territory Representative Benco Dental welcomes Phillip Barnes to the MidSouth region. Barnes attended the University of Memphis and brings nine years of sales experience to the customers in his region.

Patricia Covek – Territory Representative Patti Covek joins Benco in the Lakeside region.

Covek earned a degree in political science from St. Norbert College. She brings six years of experience to the Benco family.

Terran Distefano – Territory Representative Benco Dental is pleased to welcome Terran Chase Distefano to the Desert region.

David Guidotti – Territory Representative The Benco team in the Bay region is pleased to welcome David Guidotti. Guidotti earned a Bachelor of Science degree in business from Almeda University.

David brings 14 years of dental industry experience to the customers in his region.

Chad Jarecki – Territory Representative Chad Jarecki joins Benco Dental in the Lakeside region. Jarecki earned a Bachelor of Science degree at Purdue University. He brings four years of sales experience to the customers in his region.

Molly Kent – Territory Representative The Benco team in the SoCal region is pleased to welcome Molly Kent. Kent studied Biochemistry and Cell Biology at the University of California, San Diego.

Matthew Kinzle – Territory Representative The Benco family in the Trailblazer region is pleased to welcome Matthew Kinzle. Kinzle completed his undergraduate degree at the University of Montana and earned a degree in physical therapy from the California State University at Sacremento. He brings 18 years of dental and sales experience to the customers in his region.

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Travis Matern – Territory Representative Travis Matern joins Benco Dental in the Derby region. He brings previous experience in the dental industry to the position.

Julie Meier – Territory Representative Julie Meier joins Benco in the Carolinas region.

Meier attended the University of Mississippi and brings management experience to the customers in her region.

Jean-Paul Stanley – Territory Representative Benco Dental is pleased to welcome Jean-Paul Stanley to the Rocky Mountain region. Stanley earned a Bachelor of Science degree in business marketing from the University of Phoenix and a Master of Business Administration degree from the University of Texas at El Paso. Stanley brings seven years of experience to the Benco family.

Kevin Tucker – Territory Representative The Benco team in the Derby region is pleased to welcome Kevin Tucker. Tucker earned a degree in biology from Anderson University and a Master’s of Divinity degree from Asia and Pacific Theological Seminary. He brings 15 years of experience to the customers in his region and has participated in 30 international medical and dental mission trips.

Heather Vargas – Territory Representative Benco welcomes Heather Vargas to the Peachtree region. Vargas earned an Associate degree at Hiwassee College in Tennessee and Certified Dental Assistant certification at the Tennessee Technology Center.

Henry Schein New Appointees Brian Trippett – Field Sales Consultant Brian will be representing Henry Schein Dental in the West Virginia region. He has seven years of experience in the dental field and previously worked at Sagester Associates Group Inc. Austin Neesen – Field Sales Consultant Austin will be representing Henry Schein Dental in Omaha, Nebraska. He is new to the dental field and most recently worked for Sandhills Global as a territory sales representative. Austin graduated from Concordia University with a BA in Business.

Justin Metropolous – Field Sales Consultant Justin will be representing Henry Schein Dental in the Detroit, Michigan territory. He is new to the dental field and graduated from Central Michigan University with a BSBA in Marketing.

Brianna Yakscoe – Field Sales Consultant Brianna will be representing Henry Schein Dental in the Montgomery and Bucks County, Pennsylvania territory. She has over five years of experience in the dental field as a Certified Dental Assistant and Expanded Functions Dental Assistant. Brianna attended Harcum College and Cabrini University and received a BS in International Business.

Nicole Rimoli – Field Sales Consultant Nicole will be representing Henry Schein Dental in the Long Island, New York territory. She has one year of experience in the dental field and previously worked at Dentsply Sirona. Nicole graduated from Stony Brook University with a bachelor’s degree in Health Science.

Sean Menard – Field Sales Consultant Sean will be representing Henry Schein Dental in the Columbus, Ohio area. He is new to the dental field and previously worked as a sales representative at Group Management Services. Sean graduated Ohio University with a bachelor’s in Hospitality Management.

Lukas Popp – Field Sales Consultant Lukas will be representing Henry Schein Dental in the Omaha and Lincoln, Nebraska areas. He is new to the dental field and graduated from Kansas State University with a bachelor’s degree in Marketing and Sales.

Brittney Leigh Randolph – Field Sales Consultant Brittney will be representing Henry Schein Dental in the Houston, Texas area. She previously worked as a premium sales representative for the Houston Rockets and a suite sales executive for the Toyota Center. Brittney graduated from Sam Houston State University with a BA in Mass Communications and was the St. Jude’s Houston Young Professional Chair.

Dianna Sanchez – Field Sales Consultant Dianna will be representing Henry Schein Dental in the Houston, Texas area. She has 26 years in the dental field, 12 of which she worked for Henry Schein Dental as an equipment coordinator.

Allison Mitchell – Field Sales Consultant Allison will be representing Henry Schein Dental in the Long Island, New York area. She is new to the dental field and graduated from West Virginia University with a BA in Communication Studies and Public Relations. She previously worked for Statista as a senior key account manager.

Rada Magriso – Field Sales Consultant Rada will be representing Henry Schein Dental in the Kent, Washington region. She has 15 years of experience in the dental field as a dental hygienist and she graduated from Northwest University with an MBA in Business.

Reagan O’Donnell – Field Sales Consultant Reagan will be representing Henry Schein Dental in the Houston, Texas area. She is new to the dental field and graduated from Texas State University with a BBA in Marketing and Sales.

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NEWS

Katherine Payne – Field Sales Consultant Katherine will be representing Henry Schein Dental in the greater Chicago area. She previously worked at the University Of Dayton Sales Center and held the position of sales intern for Henry Schein. Katherine is new to the dental field and graduated from the University of Dayton with a bachelor’s degree in Marketing and International Business with a Sales Emphasis.

Annie Wu – Field Sales Consultant Annie will be representing Henry Schein Dental in the Long Island, New York territory. She is new to the dental field and graduated from the University of Albany with a BS in Public Health and Emergency Preparedness.

Lori Minarik – Field Sales Consultant Lori will be representing Henry Schein Dental in the Fort Lauderdale, Florida region. She has eight years of experience in the dental field and previously held the position of field sales consultant for SciCan. Lori graduated from the University of Texas at Austin with a BS in Merchandising.

Christina Talarico – Field Sales Consultant Christina will be representing Henry Schein Dental in the Omaha and Lincoln, Nebraska areas. She is new to the dental field and graduated from Florida State University with a BS in Professional Sales.

Chris Pinello – Field Sales Consultant Chris will be representing Henry Schein Dental in the Chicago area. He has 11 years of experience in the dental field and previously worked as a territory representative for Benco Dental where he was a member of the 2.5 million sales club.

Koy Schneiter – Field Sales Consultant Koy will be representing Henry Schein Dental in the Des Moines, Iowa territory. He is new to the dental field and graduated from the University of Iowa with a BBA in Finance.

Dion Chavis – Field Sales Consultant Dion will be representing Henry Schein Dental in the Memphis, Tennessee area. He has a year of experience in the dental field and he was a nuclear technician in the U.S. Air Force for 15 years. He graduated from Trident University with a BS in General Business.

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Ryan Lee – Field Sales Consultant Ryan will be representing Henry Schein Dental in the Boise, Idaho region. He is new to the dental field and previously worked at Smith & Nephew. He graduated from Washington State University with a BA in Business Administration.

Maya Levine – Field Sales Consultant Maya will be representing Henry Schein Dental in the Albuquerque, New Mexico territory. She is new to the dental field and graduated with a BS in Biology and Chemistry from New Mexico State University.

Skyler Holt – Field Sales Consultant Skyler will be representing Henry Schein Dental in the Salt Lake City, Utah area. He is new to the dental field and previously worked as district manager for ADP. Skyler graduated from Utah State University with a BS in Marketing.

CJ Jones – Field Sales Consultant CJ will be representing Henry Schein Dental in the Dallas, Texas area. He is new to the dental field and worked as a sales associate for Sewell Automotive.

CJ graduated from East Texas Baptist University with a BA in Criminal Justice.

Megan Kalkofen – Field Sales Consultant Megan will be representing Henry Schein Dental in the Fresno, California area. She is new to the dental field and graduated from Kansas State with a BA in Communications.

Rachelle Harr – Field Sales Consultant Rachelle will be representing Henry Schein Dental in the Minneapolis, Minnesota and the Bismarck, North Dakota territories. She is new to the dental field and graduated from North Dakota State University with a BS in Marketing. Rachelle also has her sailing certification.

Michael Jordan – Field Sales Consultant Michael will be representing Henry Schein Dental in the Fairfield County and Wallingford, Connecticut areas. He has three years of experience in the dental field, one of which he worked as a product specialist at Centrix, Inc. Michael graduated from Eastern Connecticut University with a BS in Biology.

Kate Luttrell – Field Sales Consultant Kate will be representing Henry Schein Dental in the Knoxville, Tennessee and tri-cities territory.

She has five years of experience in the dental field where she worked as an operations manager at Aspen Dental.

Brenden Blunier – Field Sales Consultant Brenden will be representing Henry Schein Dental in the Chicago, Illinois area. He is new to the dental field and previously worked as a sales representative for Takeda Pharmaceuticals. Brenden graduated from Illinois State University with a BS in Integrated Marketing Communication.

Andrew Weaver – Field Sales Consultant Andrew will be representing Henry Schein in the Denver, Colorado territory. He is new to the dental field and previously worked as an investment real estate professional at RE/MAX. He is a Special Olympics volunteer and is a member of the Real Estate Investment Association. Andrew graduated from the University of Wisconsin-Milwaukee with a bachelor’s degree in Business Administration.

Adam Hobbs – Field Sales Consultant Adam will be representing Henry Schein Dental in the Milwaukee, Wisconsin territory. He is new to the dental field and graduated with a BBA in Finance from the University of Iowa.

Molly Crabtree – Field Sales Consultant Molly will be representing Henry Schein Dental in the South Boston territory. She is new to the dental field and graduated from the University of Dayton with a BS in Business Administration.

Victoria Uminsky – Field Sales Consultant Victoria will be representing Henry Schein Dental in the Waltham, Massachusetts area. She is new to the dental field and graduated from High Point University with a BS in Sales.

Carly Gleason – Field Sales Consultant Carly will be representing Henry Schein Dental in the New Orleans, Louisiana territory. She is new to the dental field and worked as a B2B sales representative at Staples Advantage. Carly graduated the University of South Carolina with a bachelor’s degree in Business Management, Marketing, and HRTM. Brian Carr – Field Sales Consultant Brian will be representing Henry Schein Dental in the Syracuse, New York region. He is new to the dental field and previously worked for six years at Gotch Innovations. Brian graduated from SUNY Potsdam with a BA in Political Science.

Taimur Akram – Field Sales Consultant Taimur will be representing Henry Schein Dental in the northern Los Angeles region. He is new to the dental field and previously worked as a sales consultant for Apple. Taimur graduated from Western Michigan University with a BA in Business Administration.

Kelly Hargraves – Field Sales Consultant Kelly will be representing Henry Schein Dental in the Houston, Texas area. She has five years of experience in the dental field and previously worked for National Oilwell Varco and the U.S. Air Force. Kelly graduated from Colorado Technical University with a bachelor’s degree in Sales and Marketing.

Lea Kendall – Field Sales Consultant Lea will be representing Henry Schein Dental in the Maine territory. She is new to the dental field and graduated from Plymouth State University with a BS in Marketing and Professional Sales.

Jade Jaber – Field Sales Consultant Jade will be representing Henry Schein Dental on the Pacific Coast, California. He is new to the dental field and previously worked as a branch manager for Enterprise Rent-A-Car for over two years. Jade graduated from California State University, Northridge with a BA in Communication Studies.

Caroline Holmes – Field Sales Consultant Caroline will be representing Henry Schein Dental in the Birmingham, Alabama territory. She is new to the dental field and previously worked at Xerox in a B2B sales position. Carolina graduated from the University of Alabama Birmingham with a BS in Medical Industrial Distribution.

Lexis Fuller – Field Sales Consultant Lexis will be representing Henry Schein Dental in the Houston, Texas area. She is new to the dental field and graduated from Texas State University with a bachelor’s in Marketing with a Sales Concentration.

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WHAT YOU MAY EDITOR’S NOTE HAVE MISSED

BY ANTHONY LAURA THILL STEFANOU, DMD, FOUNDER, DENTAL SALES ACADEMY

Addressing Oral Cancer The mouth may

provide a window to one’s overall health, but unless patients receive regular checkups by a doctor or dentist, there’s no one looking in and serious issues, such as oral cancer, are discovered late. The death rate associated with oral cancer is high, according to the Oral Cancer Foundation. In addition, with the advent of HPV16, which appears to be contributing to the incidence rate of oral cancers, it’s becoming increasingly common for patients to be diagnosed with oral cancer at a younger age.

It’s true, Oral Cancer Awareness Month is not until April. Nevertheless, distributor sales reps can do their dental customers a service by reminding them to remain diligent year-round and educate their patients on the importance of scheduling regular checkups.

Unfortunately, most people fail to see their dentist on a regular basis, notes Jason Genta, DDS, vice president of clinical affairs, DecisionOne Dental Partners, Schaumburg, Illinois. “Unlike

The death rate associated with oral cancer is high, according to the Oral Cancer Foundation.

In addition, with the advent of HPV16, which appears to be contributing to the incidence rate of oral cancers, it’s becoming increasingly common for patients to be diagnosed with oral cancer at a younger age.

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skin or other tissues that can be easily seen, the oral cavity is a compact, dark area,” he points out.

“If something in the oral cavity does catch a patient’s attention, and he or she seeks advice from a dentist, it’s likely the issue has been developing for quite some time.”

“Dentists today must educate patients that a dental exam is a crucial component to comprehensive healthcare,” says Genta. Indeed, after an informed public that is knowledgeable about the risk factors for oral cancer, the dental community is the first line of defense in early detection of the disease, according to the Oral Cancer Foundation, noting that opportunistic cancer screenings can potentially yield tens of thousands of opportunities to catch oral cancer in its early stages.

As sales reps know very well, dental professionals require a range of tools to provide the best possible care. From sophisticated technology to basic consumables and, yes, even a shared First Impressions article about the risk of oral cancer, when reps keep their customers informed and prepared, everyone – from doctors to patients – benefits.

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