Shift Magazine - Spring 2020

ISSUES IN P E D I AT R I C DENTISTRY

SPRING 2020

EXERCISE IN YOUR OFFICE

HOW YOU CAN REDUCE OCCUPATIONAL INJURY

INVESTING IN AN ALL-TISSUE LASER IS NOW THE RIGHT TIME?

RESTLESS

SLEEP

PEDIATRIC AIRWAY QUESTIONS RELATING TO OBSTRUCTIVE SLEEP APNEA IN CHILDREN

HUMAN RESOURCES

KNOW WHAT TO DO HOW DO I BRING “PEOPLE” BACK TO MY PRACTICE?

COVID-19

DENTISTS ON THE FRONT LINE IN A NEW YORK CITY ICU

Sprig’s

10 YEARS

OF SUCCESS

FANCY-LOOKING

SAM

THE REAL STORY OF A LITTLE BOY WHO FOUND THE COURAGE TO TALK TO HIS CLASSROOM SWEETHEART

Staying Positive IN A WORLD GETTING READY FOR A HARD RESET

SIMPLE SOLUTIONS TO REAL CHALLENGES. Learn fast, easy, and proven clinical techniques at every Sprig University workshop.

Featuring hands-on instruction with Zirconia crown clinical experts.

SPRIGUSA.COM/2020 $100 OFF WITH CODE: SHIFT Cannot be combined with other offers. Offer expires 6/30/20.

MARINA DEL REY, CA September 4th DALLAS, TX October 3rd

LAS VEGAS, NV November 12th with Sprig Live!

MIAMI, FL December 11th

CONTENTS SPRING ISSUE 2020

12

LETTER FROM THE EDITOR

20 BUSINESS CHALLENGES

The Gift of Time

Simple things that make a big difference

14

24 DOCTOR TO DOCTOR

CONTRIBUTORS

Without whom this issue would

not have been possible

10 ON THE SCENE Spending good times with friends at all the Sprig-attended events over the last year

18 HEALTHY CORNER

How putting a spring in your step can help your health

22

Hear from a colleague how attending Sprig University improved the way he practices

32 FANCY-LOOKING SAM

The real story of a little boy who found the courage to talk to his classroom sweetheart

34 CONFRONTING COVID -19 On the front lines in New York City

38 INVESTING IN AN ALL-TISSUE LASER

REAL STORIES

Is now the right time?

The power of positivity

32

FANCY LOOKING

SAM

34 4

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38

WO N D E R I S TAG E N CY.C O M

CONTENTS SPRING ISSUE 2020

44 A DENTIST’S GUIDE TO BODY MOBILITY

How you can reduce occupational injury

52 STAYING POSITIVE

In a world on lockdown—twelve ways to control stress and energize your life

58

GETTING READY FOR A COMEBACK How do I bring “people” back to my practice?

64 RESTLESS SLEEP

Pediatric airway questions relating to obstructive sleep apnea in children

70 DOING IT RIGHT

An interview with Brenda Hansen celebrates 10 years of Sprig success

44 ON THE COVER EVERYTHING IN OUR WORLD IS CHANGING — IT WILL BE UP TO US TO DEFINE WHAT WE CHOOSE AS THE NEW NORMAL. COVER DESIGN BY JEFFREY P. FISHER, DDS

This issue of Shift magazine features many articles dealing with the idea of questioning; what to do in a variety of circumstances.

On page 58, Paul Edwards shares how the novel coronavirus has and will continue to affect dental offices and how this “new normal” could affect Human Resource considerations in your practice.

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52 58

STAYING POSITIVE in a world on lockdown

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HERE’S TO 10 YEARS Ten years ago, Sprig created an entirely new kind of pediatric crown.

For an entirely new generation of pediatric patients. Our crowns are unbelievably thin, remarkably strong, and stunningly beautiful. EZCrowns allow children's smiles to look better than you ever imagined. We don’t tell children how to smile, we just give them a reason to.

SOCIAL NETWORK

PEOPLE, PLACES AND PARTIES

Dr. Chrystle Cu, Cocofloss founder

EXCITING

Theresa, Cassidy, Dr. Jen Datwyler, and Hayley

Our first ever team event, Sprig Live was a huge success. The CE was amazing, but the friendships we built were even better.

Pam McDonough and Rose Dodson of Sedation Resources

Forrest Lutz, Laura Maly, Michael Anderson and Chris Dumas of Wonderist Agency

Dr. Jared Poplin and Brian Vujnovich from Solea Dr. Payam Ataii - Speaking on behalf of Shofu

Relaxing by the pool after a great day of CE Dr. Jamie Marchi and Dr. Andi Igowsky enjoying the mirror photo booth

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Dr. Yasmin Kottait training doctors to prepare and place EZCrowns

Dr. Jeffrey Fisher with Dr. Yasmin Kottait and Brenda Hansen awarding an attendee with a pair of Apple AirPods

Dr. Takish Ziad with Brenda Hansen and Cynthia Cacho at AEEDC in Dubai

Dr. Jeffrey Fisher teaching the Sprig preparation and seating technique

FRIENDS We had a great time meeting new friends from around the world who attended AEEDC in Dubai. We met many new doctors who were eager to learn about Sprig products.

AEEDC attendees learning how to prepare and place Sprig EZCrowns

EVENTS sp r ig u sa.co m / S p r i n g 2 02 0

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LETTER

from THE

EDITOR

THE GIFT OF TIME The past decade has been anything but boring. Apple introduced the world

to the very first iPad in 2010. You might have been nominated by your much-younger kids for the “ice bucket challenge,” all while they were playing with those annoying fidget spinners.

The Deepwater Horizon oil spill, the death of Osama Bin Laden, Lance Armstrong admitting to using performance-enhancing drugs, Donald Trump becoming president—all occurred this past decade. And the list could go on.

It seems crazy to me how the older I get, the faster time seems to fly. More and more frequently I say things like, “Oh, it’s been at least six months since …” as my wife gently reminds me that the event in question happened well over three years ago.

Many of us have also made life-altering decisions over the past decade. Some of us have gotten married. Graduated from our residency. Opened our first practice. Had our first child or grandchild. The list goes on and on. And while we don’t remember everything that has happened, we somehow manage to capture our most positive accomplishments and cherish our most proud moments.

Part of what comes out of reminiscing about the past is the anticipation of creating a new vision for the future. Many of us have had the time to do both over the past month or more as we all have dealt with “shelter in place” orders or other very real consequences that COVID-19 has inflicted on our planet and our practices.

For me personally, it’s crazy to think that it has been 10 years ago now that I was part of a small, start-up company that went on to change the way pediatric dentists practice all over the world—from California to New York City, Hong Kong to Dubai, Australia to Romania. Sprig Oral Health Technologies, Inc. is extremely proud to have pioneered the field of pediatric Zirconia crowns and helped shape the standard of care for children’s oral health globally. And while my kids have grown older and my hair has gotten thinner, one thing has stayed the same —my commitment to Sprig, Shift magazine, and you, our readers.

As our world transitions to remote classrooms, Zoom gatherings, and teledentistry, Shift magazine will also be transitioning to a digital format. And while this change might alter how you are used to viewing the magazine, the content and topics will remain the same—relevant and insightful for pediatric dentists in today’s busy practice environment.

In this issue of Shift magazine, read articles that focus on the future as well as reminisce about the past. Read about how dentists (dental anesthesiology residents) are working on the front lines of the COVID-19 crisis in New York City in Confronting COVID-19. Staying Positive is an article that deals with the importance of remaining optimistic in crisis and uncertainty, while Getting Ready for a Comeback focuses on the HR considerations of bringing employees back to work. Restless Sleep discusses obstructive sleep apnea in a Q&A-style article featuring pediatric dentists and a pediatric ENT surgeon. A Dentists Guide to Body Mobility, provides practical exercises you can do in your office and Investing in an All-tissue Laser discusses why it might be time to look into laser therapy. Fancy-looking Sam is the real story of a little boy who found the courage to talk to his classroom sweetheart. And Doing It Right—Sprig Celebrates 10 Years shares the story of the success Sprig has experienced over the past decade.

When I was 7-years old, I was run over by a farm tractor in Taiwan. While I was lying in my hospital bed for two months recovering in traction from two broken femurs and a fractured pelvis, I remember getting a gift. It was a small plaque that I put on my night stand that read, “Forgetting those things which are behind, and reaching forth unto those things which are before.” As we all move forward into new experiences and challenges in 2020 and beyond, my hope for all of us is that we will look for the positive in life and keep pressing forward.

Je rey P. Fisher, DDS Editor-in-Chief editor@sprigusa.com 12

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(404) 495-4895

www.profi2020.com

MEET THE

CONTRIBUTORS TO SHIFT MAGAZINE

Chelsie Cassell, DMD Salar Ebrahimi, DDS, MS Thomas Whitmer, DMD Drs. Cassell, Ebrahimi, and Whitmer are currently firstyear dental anesthesiology residents at Jacobi Medical Center in New York City. Chelsie Cassell, DMD, is a 2019 graduate of the James B. Edwards College of Dental Medicine at the Medical University of South Carolina. Salar Ebrahimi, DDS, is a 2019 graduate of Howard University College of Dentistry, Washington, D.C. Thomas Whitmer, DMD, is a 2018 graduate of Tufts University School of Dental Medicine in Boston, Mass. and completed a GPR at the Lebanon VA Medical Center in Lebanon, Penn. in 2019.

Jarod Johnson, DDS Dr. Jarod Johnson earned his Bachelor of Science in biomedical engineering and DDS degree from the University of Iowa. He went on to complete his certificate in pediatric dentistry from the University of Nevada, Las Vegas, School of Dental Medicine. Dr. Johnson currently owns and operates Arctic Dental in Muscatine, Iowa. He is also an assisting adjunct professor at the University of Iowa College of Dentistry and Dental Clinics. Dr. Johnson serves as the host of The Sprig Podcast and shares a strong passion for education and promoting the profession of pediatric dentistry.

Roger D. Gallant, MD Dr. Roger Gallant graduated from the School of Medicine at Loma Linda University in 1994. He currently practices emergency medicine part time at John C. Fremont Healthcare District, a small critical access hospital in Mariposa, Calif. Dr. Gallant is also the medical director of the NEWSTART Lifestyle Program at Weimar Institute in Northern California.

NEWSTART is an 18-day residential lifestyle program where patients are taught lifestyle principles designed to improve their health. NEWSTART is an acronym for Nutrition, Exercise, Water, Sunlight, Temperance, Air, Rest, and Trust in God.

Cathy Jameson, PhD Dr. Cathy Jameson is the founder of Jameson Management, an international dental management, marketing, and hygiene coaching firm that focuses on dental practices, including pediatric dentistry. As a speaker, she delivers entertaining and educational programs to audiences worldwide. Cathy is a best-selling author. Her most recent title is Creating a Healthy Work Environment.

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Lawrence Kotlow, DDS

Paul Edwards

Dr. Lawrence Kotlow graduated from SUNY Buffalo Dental School and completed his pediatric dental residency at the Children's Hospital in Cincinnati, Ohio.

Since 1974, he has been in private practice in Albany, New York. He became a fellow of the American Board of Pediatric Dentistry in 1980. Dr. Kotlow is an expert on aiding mothers whose infants have tongue and lip ties achieve a comfortable and effective latch during breastfeeding. He has served on the Academy of Laser Dentistry (ALD) board of directors and has earned ALD Master status, recognized to certify other dentists in the standard level certification of laser use. Dr. Kotlow has contributed textbook chapters on laser dentistry and lactation and published articles in a number of professional journals.

Paul Edwards is the CEO and co-founder of CEDR HR Solutions, a leading provider of on-demand HR support for dental practices of all sizes and specialties across the United States. With over 25 years of experience as a manager and business owner, Paul is well known throughout the dental community for his expertise when it comes to solving HR issues that impact dental practice owners and managers. He specializes in helping dentists successfully handle employee issues and safely navigate the complex and ever-changing employment law landscape through his company’s customized employee handbooks and support center.

Tsung Ju O-Lee, MD Dr. T.J. O-Lee is the chief of pediatric otolaryngology / head and neck surgery at Loma Linda University Children’s Hospital in Southern California. His research interests include pediatric obstructive sleep apnea and congenital anomalies.

Graham L. Hearn, DDS, MSD Dr. Graham Hearn is a board-certified pediatric dentist who grew up in Central California on a family citrus farm. He has lived and practiced in California, Virginia, and Seattle, Wash. He has served as a faculty member at the University of Washington and University of the Pacific. When he’s not fixing little teeth, he enjoys hiking, skiing, biking, climbing, and travel.

Mason C. Hearn, DPT Dr. Mason Hearn received his doctor of physical therapy degree from San Diego State University in May 2020. He also grew up working on his family citrus farm, then studied at UC Davis before moving to San Diego for his masters and doctoral degrees. When he’s not helping people move properly and recover from injury, you’ll find him surfing, reading, and playing guitar.

Mary Ellen Kilpatrick Mary Ellen is an Oklahoma City-based strategic communications professional. She joined the Gooden Group, a public relations firm, after graduating from The University of Texas at Austin with a degree in journalism.

Mary Ellen serves on the board of local nonprofit HeartLine, and enjoys coaching volleyball with her husband Ryan.

… without whom

THIS ISSUE would not be possible.

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Issues in Pediatric Dentistry Previously published biannually as EZPEDO Magazine 2015—2016.

Vol. 6 No. 1 | Spring 2020

JEFFREY P. FISHER, DDS Editor-in-Chief TIMOTHY SHAMBRA Layout Designer

JAMES R. FISHER, MSPH, PhD Senior Consulting Editor

RICKY QUINTANA Issue Coordinator

STACEY SCHOELLERMAN Graphic Designer

ANN FISHER, MAT, MMus Copy Editor/Proof Reader

Contributing authors Roger D. Gallant, MD / Jarod Johnson, DDS / Cathy Jameson, PhD / Paul Edwards / Lawrence Kotlow, DDS / Chelsie Cassell, DMD / Salar Ebrahimi, DDS, MS / Thomas Whitmer, DMD / Tsung Ju O-Lee, MD / Graham L. Hern, DDS, MSD / Mason C. Hearn, DPT / Brenda Hansen

Contributing photographers Stacey Schoellerman / Timothy Shambra / Garrett Hanes

Special thanks to Leslie Butler, DDS / Mana Saraghi, DMD / Abhishek Bhaumik, DDS / Rachel Bresler, DMD

SPRIG ORAL HEALTH TECHNOLOGIES, INC. Publisher JOSEPH SANDOVAL Advertising Sales

LYUBA KOLOMIYETS Finance & Accounting

WENDY CUEVA

Advertising Contracts

For editorial enquiries please email: editor@sprigusa.com For advertising enquiries please email: joseph@sprigusa.com Subscriptions are available online by visiting: sprigusa.com/magazine For additional enquiries please call: 888 539 7336 / Int. (1) 916 677 1447

SPRIG ORAL HEALTH TECHNOLOGIES, INC. 6140 HORSESHOE BAR ROAD, SUITE L LOOMIS, CALIFORINA 95650

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Shift magazine, a contemporary dental publication highlighting relevant topics of interest for busy practitioners in private practice, publishes scientific articles, case reports, and human-interest stories focusing on current issues in pediatric dentistry. Pediatric and general dentists will learn about new concepts in restorative treatments and the latest innovations in techniques and products, all available in the one magazine that helps them keep pace with rapid changes in pediatric dentistry. © Copyright 2020 Shift magazine, a subsidiary of Sprig Oral Health Technologies, Inc. All Rights Reserved.

Sh i f t m ag az in e / Sp rin g 2020

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HEALTHY CORNER

Step up your game How putting a spring in your step can help your health.

by Roger D. Gallant, MD

How are you doing with the quarantine? Have you got cabin fever yet?

Exercise is a great way to handle stress in your life.

Research shows that stress has negative effects on both blood pressure and blood sugar and that it increases inflammation. Research also shows that exercise neutralizes these negative effects of stress on our bodies.

Active people are sick less often, have more energy, and are more successful at weight management. They cope better with stress, handle pressure better, experience less depression, and have a more positive self image.

Walking boosts immunity through increasing natural killer cells, white blood cells, and other immune system mediators. It also boosts endorphins and improves circulation of your blood. Improved circulation carries these immune mediators to every cell in your body to protect you from infection.

According to the CDC and the American College of Sports Medicine, “Every US adult should accumulate 30 minutes or more of moderate intensity physical activity on most, or preferably all, days of the week.�

So what does that mean? I recommended that we get 60 minutes of exercise per day, and walking is one of the best forms of exercise. I define moderate intensity as being able to keep up a conversation while you are 18

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walking. Moderate intensity walking is easier on your body and does not put as much stress on your joints as some other forms of exercise.

Experts believe that early morning is the optimal time to exercise because air quality is generally better then. Plus, early morning exercisers tend to stick to a schedule better and stay on track.

The more you exercise, the more it increases your levels of HDL which is your good cholesterol. Interestingly enough, women who walked more than one hour a day had a 50 percent reduction in their risk of heart disease.

For women, the intensity level had less impact than the duration of exercise. Men may be capable of taking a more intense walk, but for women, spending a minimum of that one hour daily is most important.

If you find that you have a little more free time, put it to good use. Go and take a walk outside today!

Interesting

Fact:

women who walked more than one hour a day had a 50 percent reduction in their risk of heart disease.

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BUSINESS CHALLENGES | Simple things that make a big difference

Am I at Risk of Embezzlement

Within My Practice?

by Leslie Butler, DDS

Embezzlement is something no one expects will ever impact his or her practice. It is something that happens to others, right? Sadly, it happens to many dentists, usually by someone they trust the most. Embezzlement is not something that can be prevented 100 percent of the time, but at least you can take steps to help reduce the risk of someone embezzling from your practice.

Preventive Tips Here are some precautionary actions you as a practice owner can adopt to help you avoid becoming the victim of embezzlement: 1.

Remember, only you should . . .

• • • • • •

2.

Pick up the practice mail. (No one touches it but you.)

Sort the office mail.

Open all insurance EOB’s.

Remove all insurance payment checks.

Handle checks/deposits.

Complete and process all bank deposits.

Other safety precautions to take: • • • • • • • • •

Always use a bank scanner to handle checks/deposits.

Don’t issue returns or refunds on credit cards; issue checks instead.

Scan into patient charts the driver’s licenses for all parents making payments.

Make photo copies of all personal checks collected and add them to the day sheet.

Review day sheets daily, go over daily deposits and all payments, and then verify they are correct.

Don’t allow anyone other than the doctor to make any adjustments or refunds in a patient ledger.

Keep all financial records in a locked cabinet at your office.

Install security cameras in your office where financials are kept.

Keep an Excel spreadsheet recording all cash payments; compare this file daily/weekly/monthly to make sure all cash in the practice is accounted for.

Within my practice, I have implemented a system that incorporates each of these actions. The system does not guarantee that my practice will never be embezzled. However, I know that I have done my best and practiced due diligence in preventing embezzlement from occurring in the future.

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REAL STORIES | The Power of Positivity

“We’re all in this together w/ COV ID-19. Doc Bresler's Cavity Busters pediatric dental practice is closed, but its staff sends an inspiring message, THE POWER OF POSITIVITY,

to their employers.”

0

ne pediatric office in Philadelphia is spreading a message of positivity and hope in these trying times.

It’s important, especially during times of uncertainty, to always look for the bright side of any situation.

Doc Bresler’s Cavity Busters employees are pulling together as a team in a very unique way, showing the world that even during this global COVID-19 pandemic they are still one team— whether together or apart.

As dental offices across the country are closed (except for emergency care) and most of us have a little extra time on our hands, let’s use that time to remember what we do have.

Wonderful patients. An amazing staff.

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And a profession, that no matter what the circumstance, always has the opportunity to put a smile on our faces. After all, this is pediatric dentistry, and we are used to adapting to challenging situations. As a close friend of mine always says, “Plan, plan, plan, and then plan to be flexible.” It’s good advice.

So as we face the weeks and months ahead, remember to take some time to slow down and be thankful…

Before you know it, we’ll all be back at our fast-paced jobs and wishing we had a little more time to spend at home with family.

The power of positivity is infectious, and that’s the kind of infection that this world needs right about now!

Top left: A group image created by the doctors and sta of Doc Bresler’s Cavity Busters, a pediatric dental practice in Philadelphia and the suburbs. The caption contains a message written by Drs. Rachel, Jason and Josh Bresler, owners of the practice, thanking their sta for being their Cavity Busters family.

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DOCTOR-TO-DOCTOR TESTIMONIAL

CONFIDENCE. Why I chose Sprig University

Prior to opening my o ce two years ago, I made one of the best decisions by investing time and energy to learn how to place Sprig EZCrowns at a Sprig University course. At first, I was slow with placing these crowns compared to seating a traditional SSC, but in due time I became faster at placing Sprig Zirconia crowns and now it is reassuring seeing my patients’ X-rays during recall visits and noticing that the teeth are healthy and beautiful.

I love this company and their people. They have amazing customer service, and I believe Sprig EZCrowns are the most esthetic and most durable Zirconia crowns in the market.

My patients and parents love these crowns!

Abhishek Bhaumik,

DDS

Frisco, TX

Dr. Bhaumik’s personal mission in life is to be the best role model he can be for children around the world. At his practice, Stonebrook Pediatric Dentistry, his mission statement is to provide mentorship and guidance through pediatric dentistry. He believes the time his team spends with children during their check ups and cleaning appointments allows them to instill good values and serve as role models for the children in their community. When not at the office, Dr. Bhaumik loves spending time with his wife, Elisa, planning their future, working out, traveling and volunteering.

sp r ig u sa.co m / S p r i n g 2 02 0

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NOT 100 % SURE

Q An Honest

QUESTION? Are you truly satisfied with your current Zirconia crown? If not, now might be the time to discover why so many dentists are talking about Sprig.

Design Contours

Flat-Fit™ Engineered to be easier to seat and require less tooth reduction.

• • • •

flattened occlusal profile less occlusal reduction needed broader bucco-lingual dimensions more roomy internal cavity relaxed interproximal undercuts more space to fit back-to-back crowns faster seating saves chair time

Because it all starts with the right shape.

Patented Retention

Zir-Lock® The world’s first pediatric Zirconia crown is also the most retentive.

• • • •

How important is retention to you?

patented retentive grooves creates mechanical retention twice the internal surface area maximizes cement-surface bond margin-lock feature prevents marginal cement washout use any cement you choose works with both GI and RMGI

Modified Shape

Space-Loss™ Think of them as your “Howe pliers” for pediatric Zirconia crowns.

• • • •

‘pre-squished’ for you exactly the right design from the start narrower mesio-distally matches finished rectangular prep shape broader bucco-lingually large enough to fit passively available in cuspids, 1st and 2nd molars SL collection labeled with red ink

We “squished” them for you.

Natural Finish

Polychromatic Hand-finished details that make EZCrowns look so realistic.

• • • • •

EZCrowns are truly in a class of their own.

individually hand finished unique like natural living teeth mirror-polished functioning surfaces ultra-low wear on opposing dentition gingival third lightly stained matches natural cervical color glazed on esthetic surfaces reduces light reflectivity one polychromatic shade one inventory is all you need

TRY SPRIG TODAY.

A The Honest

ANSWER. At Sprig, we don't o er any gimmicks or half-truths to get your business. Just honest solutions to your biggest clinical challenges. Over the last 10 years, one thing has never changed—our commitment to you. Discover the di erence EZCrowns can make in your practice by letting us prove it to you. Ask us about our trade-in program today.

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REAL STORIES | How Sam’s smile changed his life.

LOOKING YOUR BEST: When the right circumstances converge, it's easy to be confident.

And sometimes confidence is all you need.

THE STORY BEHIND “FANCY-LOOKING” SAM Dr. Jarod Johnson and Sam’s mom, Hannah, share a heart-felt story of how a little boy’s life was transformed—and how it affected so much more than just his smile.

by JAROD JOHNSON, DDS

IT

was a brisk autumn day in Muscatine, Iowa, and I had just finished updating a lecture I was preparing for Sprig Live, scheduled to take place in just a few days.

Needing a break, I decided to run to the grocery store and pick up some items my family needed. At the deli counter, I ran into Hannah and Joaquin, Sam’s parents.

Sam is one of the children from our office who had been featured in Sprig’s Changing Lives series. Sam has a number of unique and special qualities. He is an exceptional patient and brings joy to everyone in our office when we see his name on the schedule. He presented with decay on the mesial surfaces of his primary first molars. Sam is well mannered and was able to tolerate

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all his treatment (which included placing two posterior EZCrowns) under local anesthesia and nitrous oxide/ oxygen supplementation. While all these factors provide interesting details of Sam’s background, I hadn’t yet heard the most impactful part of his story.

Back at the deli counter, I asked Hannah, “How are Sam and his sister doing?” Earlier that week, I had mailed Sam a copy of the latest Shift magazine in which he was pictured throughout. Wanting to make sure his family received it, I inquired if the magazine had arrived. At that point, Hannah responded, “Yes, we received the magazine, and Sam took it to school to share with a girl who routinely enters beauty contests. Let’s just say she was impressed!”

LOOKING FANCY: Sam shows it’s a look that’s always in style.

by Hannah Aguilar Sam’s mother

I

remember clearly the day Dr. Johnson refers to.

I couldn’t wait to tell Dr. Johnson how excited Sam was to receive the copy of Shift magazine that highlighted him in the Changing Lives feature. The very next day, Sam took the magazine to school, completely filled with excitement, to share it with a very special girl in his life. His teacher was so impressed with the magazine that she allowed him to share it with the whole class. His fellow students now consider Sam to be “famous.” He came home overflowing with self-confidence!

Anyone who knows Sam knows he has always taken pride in his appearance—what he calls, "looking fancy.” His daily attire consists of cowboy boots, denim jeans with a belt, and a button-up shirt, tucked in, of course. His hair must be combed over nicely and all. His smile beams when he receives compliments about his attire.

Being able to preserve that natural-looking smile through the use of EZCrowns has allowed my son to display a level of self-confidence I have never seen in him before. Being featured in Shift magazine and in Sprig’s Changing Lives series has only increased his level of self-confidence. It made him feel special and unique. His infectious smile gets to stand out, for good reasons, alongside “looking fancy.”

Although the EZCrowns blend right in with his natural teeth, they are the reason behind Sam’s self-confidence.

We will be forever thankful to Sprig and to Dr. Johnson for changing his life in a most positive way.

However, what impacted me the most was hearing Hannah share how throughout the experience Sam had developed higher levels of self-confidence, how she has seen this experience have a ripple effect extending to all aspects of his life.

At this point in our conversation, my eyes began to water.

The moment was serendipitous; running into Sam’s parents and hearing his story just days before I was to travel to Sprig Live where he would likely be featured was momentous. It was truly a god-wink.

We all agree that pediatric dentistry can be fun, but it doesn’t come without challenges—managing a difficult child’s behavior, dealing with dental trauma, or, in Sam’s case, restoring a mesial surface of a primary molar. Some dentists may consider their daily routine as just providing ordinary treatment that usually consists of restorations, crowns, pulpotomies, extractions, and space maintainers on teeth that, well, are “all going to fall out anyway.”

My experience at the deli reminded me that our daily impact may be far greater than we realize. Through preparing episodes of Sprig’s Changing Lives video series, I have discovered the inspiring stories of families that come to my office. This experience has renewed my excitement as I realize that our profession is doing more than just creating healthy smiles. Sam’s story reminds us that we have opportunities to impact the kids we treat, helping to positively influence them for the rest of their lives.

STUDENTS NOW CONSIDER SAM TO BE

“FAMOUS.”

HE CAME HOME OVERFLOWING WITH SELFCONFIDENCE! sp r ig u sa.co m / S p r i n g 2 02 0

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confronting

COVID-19 on the front lines in New York City

by Chelsie Cassell, DMD Salar Ebrahimi, DDS, MS Thomas Whitmer, DMD

The following article is based on the authors’ personal feelings and does not reflect the views of Jacobi Medical Center. Details have been changed to protect patient privacy.

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I

awake to the sound of sirens going off. I open my eyes and realize it’s just the alarm on my phone screaming at me to wake up. After hitting the snooze button many times, I slowly get out of bed at 5:30 a.m. After showering and getting ready, I dress in paper scrubs so I won’t have to wear my own clothes on the subway. I carefully put on one of the few surgical masks available to me. This one was given to me by one of the hospital anesthesia staff after being shocked when I told him I wasn’t wearing a mask on the subway because I didn’t own one.

After making the hour-long commute from the Upper East Side to the hospital where I work in the Bronx, I rush inside and put my stuff away. Typically, as a dental anesthesiology resident, I would be going to the OR where I put people to sleep and wake them up every day. Instead, I head to the medical floor, recently transformed into a makeshift ICU, which the anesthesia and dental departments now oversee. I gear up in one of my two N95 masks that I won’t take off all day, except during my 20-minute lunch break.

After receiving instruction in the basics of how to function as an ICU resident, I get handoff from my co-resident who has been here working for 24 hours straight. She warns me, “Three patients coded last night and they likely won’t make it much longer.” We round past each patient’s room; all but two are intubated.

A patient begins to display abnormal rhythms. My coresident tells me, “Don’t worry. His family came yesterday to say goodbye and signed a DNR after seeing him.” I worry anyway. We watch from outside his room as he goes into asystole. Time of death is 7:52 a.m. This is the first time I’ve seen a deceased person. After he passes, someone comments, “Now his ventilator can be used for one of our other patients.”

After cleaning the recently deceased patient’s ventilator, we make it available to our other patient who desperately needs it. We continue rounding, and I receive my patient assignments. My co-resident informs me, “This patient likely won’t make it past today. A DNR is in place, and the family has said goodbye. You don’t have to do anything with him except make sure he is comfortable. I’m going to give you three patients since this one is easy.” I laugh at that statement. None of this is easy.

Another patient begins to code for the second time since coming to our ICU. We have no family contact information.

He passes away very quickly with only his doctors and nurses beside him. Time of death is 8:28 a.m. We feel sad, but at the same time all of us are also thinking how good it is to now have another spare ventilator available.

After finishing rounds, it is close to 10 a.m. My co-resident has now been working non-stop for 27 hours. Our attending implores her, “Please leave.” Before she does, however, she remembers a promise to call the family of the first man who passed away. After letting them know of his passing, she then finally goes home to catch some sleep.

Throughout the day, I ask my other co-resident, who has worked before in an ICU, 1,000 questions. I’m able to manage all my patients with the support from my attendings, the nurses, and house staff. When I don’t know how to do something, I remind everyone that I’m a dentist who hasn’t done this before. Everyone seems to understand that, taking time to explain and show me what to do. I feel support from my co-workers.

We discuss the death rates of intubated COVID-19 patients.

We determine the rate is anywhere from 84 percent up to 97 percent. I’m told that the patients on our floor are the ones that the normal ICUs don’t think have a fighting chance. I feel relief again knowing that even if I make a medical misjudgment during this pandemic, it likely won’t alter the outcome. I also feel ashamed for thinking that thought.

One of my other patients isn’t expected to make it through the night, so we let his wife visit. He has acute kidney injury which I’ve been told has a 100 percent mortality rate with COVID-19. After visiting him and hearing his hopeless prognosis, the wife signs a DNR form and says goodbye to the man she has loved most of her life. I go to lunch.

Surprisingly, following lunch, things remain calm for a few hours. At 2 p.m., we go over plans again with the attendings and an infectious disease specialist. I take notes. We then set out to rotate one of the patients to his side. We determine that four people are needed to roll a patient to one side and it takes six people to place a patient in a prone position.

After we get done rotating the first patient, we prone a second one. It takes seven people 30 minutes to accomplish these tasks. I think to myself, “This is taking way too many resources.” We already are running low on supplies. I wonder if any benefit the patient might receive is worth the wasted resources. I quickly push the thought to the back of my mind.

The unspeakable has happened in your residency— a pandemic, and you are now on the frontlines.

I wake up for the patients in my unit—to care for them and hope they can sur vive this virus. I also wake up for their families to show that since they cannot be with their loved ones, I am there. I speak to them whenever they call. I comfort them as best I can as a liaison, ensuring that their loved ones are as comfortable as they can be. The frequent updates, the distressing news that my patient—their loved one—hasnʻt survived, all weigh heavily on me every night. But during these unprecedented times, we are supposed to stay strong for our patients and their families. We are on the frontlines doing our duty as healthcare professionals.

—salar ebrahimi, dds, ms sp r ig u sa.co m / S p r i n g 2 02 0

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M

any of our nurses are out with COVID-19 symptoms. One of the two nurses we have today for the 12-patient ICU (now with 10 remaining patients) answers a phone call and puts the caller on hold. She then informs us, “A patient’s mother just called for an update after she heard her son was in the hospital and might possibly have COVID-19.” The nurse returns to the caller and asks, “What is your son’s name?” It’s the man who passed away at 8:28 a.m. We transfer the mother’s call to our attending who delivers the sad news. We feel defeated and take a few minutes to chat about how we feel. This discussion helps me process my feelings, and I decide I will be able to get through this experience with my work family at my side.

We do as much work as possible to decrease the number of details my co-resident reporting for night shift will need to look after. Unfortunately, he will still need to clean up a patient whose family is coming to see him tomorrow morning to say goodbye. We round again, and I pass off my patients to him. I let him know that there’s nothing to do for two of my three patients because we are waiting for them to pass. Relief rushes over his face.

It’s 8 p.m., and I’m getting ready to leave and ride home on the subway in new paper scrubs. The patient whose family is coming tomorrow morning starts to code. He is DNR. I feel sad that the family cannot say goodbye but happy that my co-resident might be able to get a couple hours of sleep now that he doesn’t have to clean up the patient.

In a pensive mood, I—an anesthesia resident, a dentist, and now a recently recruited ICU doctor—have finished my first shift and find myself thoroughly exhausted. Arriving home, I carefully wash off the day’s accumulation of contamination.

My face is bruised from wearing a tightly fitting mask all day long. Now as I rest and contemplate tomorrow’s routine, I muse to myself, “Why can’t I stop putting people to sleep only to never get the chance to wake them up again?”

Battle scars After 24 hours of intense p atient management and care, Chelsie still bears the marks of a stressful day.

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Though my time in the ICU has been tough, it has also been one of the most rewarding things I have ever done. The knowledge I have gained during this time is invaluable and will stick with me for a lifetime. I know the family we’ve built in the Bronx will always endure. We share the bond that only grief, loss, and setbacks can create. More importantly, we share hope. The joy and love we felt while discharging our first successfully extubated COVID-19positive patient radiated throughout the room.

As a dentist, I know I will be a more skilled practitioner having faced this experience in the ICU. I will be better prepared to face whatever unexpected challenges may arise throughout my career—a most valuable asset for me as a dentist anesthesiologist and for pediatric dentists as well. I encourage everyone to get involved in your own community throughout your career because hardships don’t seem as difficult to bear when you have each other to share the load.

Many thanks to everyone for doing what you can to fight this virus.

Whether you are sheltering at home or directly ser ving your community, you are making a huge difference in conquering COVID-19. Your sacrifice and service are valued and appreciated.

— chelsie cassell, dmd

Full protective gear Margi Chan, a Jacobi Medical Center resident, in full-intubation PPE.

Small victories Chelsie with co-residents Ti any Neimar and Sarah Albani share a moment of joy after they successfully extubate a patient.

A Message from Mana Saraghi, DMD,

Director of Jacobi’s dental anesthesia residency program.

It is now April 17, 2020. Approximately one week ago, New York was experiencing a surge and nearing the peak of COVID-19 related fatalities. My residents in the ICU were facing a dire situation. Dark clouds of despair and feelings of futility had descended on us like a thick fog. Our patients were dying after a long passage that involved intubation, interventions, and difficult conversations with families.

Overhead speakers regularly announced a cardiac arrest code. Every hour it seemed the speakers interrupted any sense of calm yet again. Death was a constant reality. As soon as a bed became available, a new patient was brought in immediately. Would this process start all over only to lead to another grim ending? Are we working in heaven's waiting room? What are we doing here as dentists? The reality is healthcare providers were in short supply, and we had to put our anesthesiology training to use, forcing ourselves into situations requiring rapid and uncomfortable growth as we answered the call to serve.

Soon after the surge, intensivists, anesthesiologists, physician assistants, and critical-care nurses arrived from both the United States Air Force and the civilian sector. They brought new ideas to the table. The residents seemed to settle into their new "normal" and adapt to the ICU environment and workflow. Recently, several patients in our unit have been extubated. With each extubation, Rachel Platten's "Fight Song" plays over the intercom and the burden is lifted slightly. The overhead speakers announce fewer cardiac arrests and intubations. A small ray of sunshine is poking through the clouds.

I couldn't be prouder of our residents. They have faced physical and emotional danger with courage, grace, and humility. Each of us has been redeployed to areas that challenge our abilities and expertise.

This state of affairs is also compounded by an unprecedented and volatile situation in which the standard of care has not yet been established.

This situation is in sharp contrast to our zero tolerance for bad outcomes when planning elective dental anesthesiology where case selection and patient optimization are paramount. Our “north star” has been to do our best to promote a psychologically safe environment in which candor and humility are valued when discussing difficult subjects and when facing uncertain circumstances. Our residents have been patient, open-minded, and open-hearted. In time, the sadness and grief will recede, and I will choose to remember the amazing ways in which these empathetic and talented residents met this challenge.

Intubating patients, placing lines, and monitoring sedation are all skills that I am used to as a dental anesthesia resident, but now my responsibilities also include ordering chest x-rays, drawing labs, requesting consults, and talking with families about life and death decisions. As a dentist, I felt unprepared since I am not trained to manage critically ill patients, but the immediate crisis stretched hospital resources too thin to meet pre-COVID standards. The COVID pandemic has brought unexpected challenges which many describe as war. Although similarities exist, I view the stress in each life event as unique.

My time in the Marine Corps and Iraq taught me the mindset of “adapt and overcome.” I also learned to value a sense of calm in chaos.

—thomas whitmer, dmd

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Investing in an All-tissue Laser Is now the right time?

by Lawrence A. Kotlow, DDS

I often hear pediatric dentists pondering the following question. When is the right time to invest in an all-issue dental laser? For some the right time never comes. For others, it’s as soon as possible. The answer to this dilemma is really quite simple, depending on how you respond to the following questions. Do you want to be a tooth-o-dontist? Are you satisfied to just “drill and fill?” Or, do you want to be a physician of the oral cavity?

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9300NM CO2 ALL-TISSUE LASER: Controls laser energy by use of a foot pedal rheostat to ablate hard and soft tissue.

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s dentistry and medicine merge closer together, the pediatric dentist should be in the forefront of understanding how the oral structures—teeth, jaws, and especially the tongue—can impact many of the body’s systems.1 Normal jaw and tongue positions are critical to maintaining a good patent airway for infants and toddlers as well as older children. Being a practitioner who just maintains the integrity of teeth is no longer adequate.

We also need to understand how we are in the best position to diagnose obstructive sleep apnea or sleep-disordered breathing in newborns, infants and toddlers. In addition, we must be aware of how dental infections may affect our patients’ overall health, their total growth, and their development. Tethered oral tissues (TOTS) such as the upper lip-tie and lingual ties may restrict the entire body due to the involvement of the body’s fascial system.2 Our practices need to see infants as soon as possible when mothers suffer a plethora of different breastfeeding problems related to these tethered oral tissues.

As pediatric dentists, we actually wear many hats. We may assist mothers that stress over failing to successfully breastfeed their infants and often suffer from post-partum depression, fail to successfully bond with their infants, and end up using bottles and formula. Infants with ankyloglossia (tongue-tie) may suffer from reduced oxygen flow due to blocked airways. This in turn can directly affect the respiratory and circulatory systems.3,4 Studies now indicate that ankyloglossia may also be related to infant’s developing ADD/ADHD in the future. Infants who have a restricted tongue may fail to latch securely to their mother’s breast and swallow large amounts of air, resulting in air-induced reflux, which in turn is treated with drugs by the medical profession.

We as pediatric dentists are in a position both to diagnose and help alleviate these types of conditions. Furthermore, by using an all-issue dental laser right in your own dental office, you may easily and safely correct many infant problems referenced in this article.

MAKING THE DECISION TO INVEST IN A LASER (WHAT OPTIONS ARE AVAILABLE?) First, we need to look at the benefits of laser dentistry and determine which laser is best for you as a pediatric dentist.

There are three types of lasers a pediatric dentist should be familiar with.4 In addition, you must ask yourself several questions when making your decision. What do I want to be able to do with lasers? Am I looking to do all types of dentistry—restorative, surgical, and trauma treatment? Do I want to reduce the need for local anesthetics? Or do I perhaps only want to use lasers for soft-tissue surgery?

LASER CATEGORIES AND WAVELENGTH Lasers are classified in one of two categories: 1) hot or cutting lasers, and 2) cold or non-cutting lasers. Hot lasers are lasers used to ablate hard and soft tissue and may be further classified either as all-tissue lasers or lasers limited to soft tissue surgery. Cold lasers are used in laser pointers as

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PROPERTIES OF THE IDEAL LASER

9300nm CO2 alltissue laser

Erbium family of lasers

10,600 Diode so t-tissue- family of only CO2 lasers lasers

Scissors and scalpels

Ablates dental hard tissue Ablates soft tissue

Cuts tissue

Has an aiming beam to direct laser beam Has water to cool both hard and soft tissue Eliminates numbing in the majority of hard and soft procedures

Requires numbing

Controls laser energy by use of a foot pedal rheostat Provides good hemostasis

Often requires sutures

Uses Hz, mj, and diverging beam to determine power Comparison of di erent laser properties and conventional soft-tissue surgery.

well as for cavity detection, treating trauma, and in certain non-ablation, soft-tissue treatment.

In general, lasers have specific target tissues or chromophores. The ability of a tissue to absorb a specific laser is determined by the laser’s wavelength, expressed in nanometers.

PHOTOBIOSTIMULATING LASERS The first type of laser to consider would be a photobiostimulating laser (a PBM—formerly called a low-level laser). In the practice of dentistry, these lasers cannot incise or excise tissue, but a PBM may be used to reduce the effects of traumatic injuries by decreasing swelling, improving healing, treating aphthous ulcers (canker sores), aborting herpes labialis, and lowering the need for local anesthetics.5 All lasers can produce these effects depending on the power used.

SOFT-TISSUE-ONLY LASERS The second type of laser is used for procedures involving treatment of soft tissue only. These lasers belong to either a diode family of lasers with a range of 400nm–1064nm wavelengths or soft-tissue carbon dioxide lasers limited to 10600nm wavelength only.

ALL-TISSUE LASERS The third type includes an all-tissue laser of the erbium family of lasers and the 9300nm carbon dioxide laser. These lasers are capable of ablating enamel, dentin, and bone. They may be used in all types of soft-tissue surgery.

When asked about the negatives of investing in a laser, cost is always brought up as a major negative. This objection, however, is like a lot of “false news.” Once a dentist decides to move forward and chooses the right laser for his or her practice, the return on this investment more than covers the expense and ultimately results in improved patient care. Of course, this assumes that the dentist has received correct training in the use of lasers and has an adequate knowledge of laser physics and laser safety.

I believe we have reached what businesses call the tipping point in laser dental care. The question is no longer if, but when should you invest in a laser. The pediatric dentist who does not use an all-tissue laser will soon find patients seeking out one who does.

THE 9300NM ALL-TISSUE CARBON DIOXIDE LASER Having invested in lasers since 1998, I have used a variety of equipment. Lasers I have used include an Nd:YAG (not discussed here since it is not really a laser for the pediatric dentist), erbium lasers by various manufacturers, many different diode lasers with various wavelengths, and now the 9300nm, all-tissue carbon dioxide laser. In addition to personally using many types and brands of lasers, I have lectured and taught for many of the laser manufacturers.

Based on my own experience, I have found the Solea 9300nm all-tissue laser developed by Convergent Dental to be the best.6 Among Solea’s major differences and benefits are the following. It incorporates all the benefits of hardand soft-tissue lasers into a single unit featuring a userfriendly, computer-touch-screen control panel. Solea is also the only laser using a variable foot pedal or rheostat to control laser power rather than simply employing an on-off switch. Controlling laser energy and power with this laser is similar to driving a car—you control these parameters by watching what is occurring to the tissue being treated and control ablation by controlling foot pedal pressure.

Computers control Solea’s beam size, so there is no need to change tips or handpieces during restorative or surgical treatment. All controls are fingertip controlled by the touch screen. The laser produces a safe, diode-green, laser-focus beam and allows precise water and air control during soft tissue excisions when desired.

KEEP MOST DENTAL PROCEDURES IN YOUR OWN OFFICE Referring most soft-tissue procedures to other specialists is a thing of the past. With the exception of third-molar and other bony impactions, most soft-tissue surgery can be completed by the pediatric dentist using the 9300nm laser.

Keeping all the procedures you historically referred out in your own office will more than cover your laser’s initial cost and help you realize a rapid return on your investment.

Getting the most from your laser investment, however, requires that you become educated in laser physics, laser safety, and how to optimally maintain your laser, before treating patients. A good laser manufacturer will provide inoffice demonstrations and an in-depth introduction to their laser’s capabilities. This introduction will include information on the laser’s specific settings and parameters

as well as instruction in using the laser to perform specific procedures which it was designed to accomplish.

As a pediatric dentist, you can now provide your patients a way to reduce or eliminate the fear factors dentists have been associated with—numbing, needles, lip and tongue biting.

OPERATIVE DENTISTRY WITHOUT ANESTHESIA All types of restorative dentistry—Class I-VI, anterior and posterior pediatric crowns and pulpotomies—can be completed in most patients without the need for local anesthetics. Tooth isolation using the Isolite method and a rubber dam may be accomplished using lasers to enhance treatment and care.

9300NM CO2 ALL-TISSUE LASER: Has water to cool both hard and soft tissue and uses an aiming beam to direct laser beam.

BENEFITS OF USING LASERS

(DEPENDING ON WAVELENGTH AND TARGET TISSUE)

1. Reduces the need for local anesthetics 2. Eliminates the potential for infections (lasers are bactericidal) 3. Allows more restorative treatment per visit (2–4 quadrant dentistry) 4. Reduces time away from school (for children receiving dental care) 5. Reduces time away from work (for parents who accompany their children) 6. Reduces fear factors associated with dental care 7. Eliminates post-treatment emergencies and concerns about biting cheeks, lips or tongues 8. Reduces stress for patients, parents, staff, and dentist 9. Reduces sedation and the need for general anesthesia 10. Serves as an excellent practice builder 11. Remains safe to use (when proper eye protection is used for everyone in the surgical area)

NEGATIVES OF USING LASERS 1.

Potential issues caused by improper or insufficient training 2. Perceived high cost of investment

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LINGUAL

LABIAL

FRENECTOMY

GINGIVECTOMY

TOP: Pre-surgery

TOP: Pre-surgery

BOTTOM LEFT: Immediately post-surgery

BOTTOM LEFT: Immediately post-surgery

BOTTOM RIGHT: One week post-surgery

BOTTOM RIGHT: One week post-surgery

TREATMENT

REMOVAL

TOP: Pre-surgery

TOP: Pre-surgery

BOTTOM LEFT: Immediately post-surgery

BOTTOM LEFT: Intra-operative

BOTTOM RIGHT: Four days post-surgery

BOTTOM RIGHT: One week post-surgery

PRE-HERPES LABIALIS

MUCOCELE

As a pediatric dentist, you can now provide your patients a way to reduce or eliminate the fear factors dentists have been associated with — numbing, needles, lip and tongue biting.

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SOFT-TISSUE PROCEDURES PEDIATRIC DENTISTS MAY SAFELY TREAT IN THE OFFICE 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

Lingual frenectomies Mandibular frenotomies Upper lip-ties Hemangioma removal Mucocele removal Other biopsies Fibroma removal Exposing teeth under bone or soft tissue Gingivectomies Phase-three orthodontics (recontouring gingival hyperplasia) Treatment of aphthous ulcers Treatment of herpes labials Removal of venous lake lesions Removal of fractured root tips Treatment of pericoronal tissue on erupting molars Exposing decay on partially erupted teeth/ removing excess tissue grown into decay

FINAL THOUGHTS When I first decided to invest in lasers for my patients, lasers were a new emerging technology. Today, they are no longer on the cutting-edge of pediatric dentistry. Rather, they are the standard of care which pediatric dentists should be providing for their patients. Lasers can be used in procedures involving almost every hard and soft tissue which you as a pediatric dentist may be called upon to treat in your patients. Understanding the benefits of lasers and the training which is required to use them safely should be an essential prerequisite for all dentists who treat children.

DISCLOSURE Over the years since I began using lasers, I have consulted with the former Hoya laser and Fotona laser companies. I have produced laser teaching videos, provided continuing education courses, and received honoraria. I have also consulted with various other companies (such as Isolite, Innovation Optics, and Specialized Care) dealing with laser accessories. At the present time, I provide training for dentist’s investing in the Solea laser and speak at various meetings for Convergent Dental on the benefits of the Solea laser. When Convergent offered investment options, I purchased some shares of their stock.

9300NM CO2 ALL-TISSUE LASER: Eliminates numbing in the majority of hard and soft procedures.

References 1. Hang WM, Gelb M. Airway Centric® TMJ philosophy/Airway Centric® orthodontics ushers in the post-retraction world of orthodontics. Cranio 2017 Mar;35(2):68–78. doi: 10.1080/08869634.2016.1192315. Epub 2016 Jun 30.

2. Schleip R, Findley TW, Chaitow L, Huijing PA, eds. Fascia: the tensional network of the human body. Edinburgh: Elsevier, 2012.

3. Villa MP, Evangelisti M, Barreto M, Cecili M, Kaditis A. Short lingual frenulum as a risk factor for sleep-disordered breathing in school-age children. Sleep Med 2019 Oct 23;66:119–122. doi: 10.1016/j.sleep.2019.09.019. [Epub ahead of print] 4. Kotlow L. Lasers and pediatric dental care. Gen Dent 2008 NovDec;56(7);618–27.

5. Kotlow, L. Photobiomodulating lasers and children’s dental care.

J Laser Dent 2009;17(3):125–130.

6. Fantarella D, Kotlow L. The 9.3-µm CO2 dental laser: technical development and early clinical experiences. J Laser Dentistry 2014;22(1):10–27.

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A Dentist‘s

GUIDE TO BODY MOBILITY

How You Can Reduce Occupational Injury

by Graham L. Hearn, DDS, MSD & Mason C. Hearn, MS, DPT

As dental professionals, most of us have been taught, reminded, or even reprimanded about the care of our bodies while at work. Posture, ergonomics, and equipment were topics likely reviewed in dental school and remain in the back of our minds as we practice. However, the responsibility to take care of our bodies while at or away from work is an individual choice, and we live with the consequences and rewards of our actions.

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This article presents information for dentists about our body movements and how they relate to the work we do. We will look at how we should take care of our bodies and outline some practical techniques to help keep our body mechanics functioning optimally both in and out of the office.

The reality of practicing dentistry—pediatric dentistry, especially—is that even when our backs or necks ache, we still have to adjust the disto-lingual line angle on a wiggly 4-yearold, then crane our necks the very same day to show a parent caries on an upper second molar. Rinse, dry, repeat. Maybe in your practice these motions happen often, maybe they don’t.

The reality is that even the most ideal posture and movements needed for dentistry and working with children aren’t always healthy and natural for our bodies.

How many of us choose to make time for exercises that help strengthen muscles that we abuse or neglect as dentists? How many of us have a physical therapist who has tailored an exercise program to keep us as healthy as possible? If that’s you, pat yourself on the back and stop reading now because you’re already on top of the situation. Or, keep reading, because you might find something new and useful here.

Just like an athlete who is expected to perform on the court or the field, we are expected to perform daily with the handpiece and mirror in hand. Whether you’ve been practicing for one year, ten years, or fifty years, we hope you find a take-away that improves your life, or at least encourages you to think about the merits of self-care and thoughtful exercise.

I (Graham) teamed up with my brother Mason, who just finished his Doctor of Physical Therapy, and who has coached me extensively on training programs and exercises to improve my body mechanics. We’ll talk about and demonstrate exercises that can mitigate the potential harmful effects of everyday work in dentistry. We discussed what this means for our bodies and created a framework, in the form of exercises and reminders, to improve and maintain healthy body mechanics. We hope you are able to put the following exercises to use in your life and daily practice and thereby reduce your risk of dentistry-related injury.* *The following content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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Section 1 —Mobility and Strengthening Exercises

Step 2

1. Isometric retraction/elongation Lie on your back without a pillow under your head (Step 1). Tuck your chin (see down arrow) in to press the back of your head flat on the floor (or into a bed) and pull yourself taller as if something attached to the top rear portion of your head is pulling (see right arrow) to elongate your neck (Step2). Return to the initial position and repeat. Perform this exercise for three (3) sets of 10 repetitions. This can also be performed while seated, such as against the headrest in a car on the way to/from work; however, for best results perform in a supine position.

Step 1

The responsibility to take care of our bodies while at or away from work is an individual choice.

2. Thoracic extension mobility Place a foam roller on the floor and lie on your back with your knees bent and the foam roller at the level of your shoulder blades. With your arms behind your head for support, lower your head and shoulders as close as you can to the floor until you feel a stretch behind your back. This can be performed segmentally by moving the placement of the foam roller 1–2 inches up and down the spine between the level of the shoulder blades down to the mid back. You can also work the foam roller up and down your back in smooth motions for a more massage-like effect. If your foam roller is below the level of your ribs, you’ve gone too far.

Step 1

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Step 2

We live with the consequences and rewards of our actions.

3. Cat and dog stretch

Step 1 Step 1

Step 2 Step 2

Start on all fours with your back straight, hands under the shoulders and knees under the hips. To do the “dog stretch,” slowly inhale and let the belly fall toward the floor to arch the back downward and extend the head upward at the same time. Try to create as much of a “U” shape as possible between the pelvis and head (Step 1). To do the “cat stretch,” slowly exhale, round the back upward and tuck the chin to the chest (Step 2). Alternate between these two positions slowly. You should be feeling this motion as a “rolling” of the pelvis and as an arching of the spine in both “cat” and “dog” motions.

4. Thread the needle Start in a four-point position with your hands directly under the shoulders and the knees under the hips. Keep your chin in, back straight and shoulders back. Using one arm to stabilize your body, raise the other arm off the floor and reach under the stabilizing arm as far as possible, rotating and rounding your upper back downward as you lower the shoulder of your moving arm (Step 1). Then retract your moving arm and reach vertically as far as possible (Step 2). This movement can be modified by placing a foam roller on the outside of your stabilizing hand and using the foam roller to facilitate the movement in the first picture below.

Step 1 Change stabilizing hands and repeat with the other arm. Hold each end-range position for 1–2 seconds while continuing to breathe before reaching in the opposite direction.

Exercise reduces the chance of chronic pain.

Step 2

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5. Suboccipital release Using athletic tape, fasten two tennis balls together so that they are firmly affixed next to each other. Place the balls underneath your neck at the base of your skull while lying on your back with your knees bent. Tuck a small hand towel between the tennis balls and your upper back to keep the balls from sliding. Hold this position for 10–15 seconds before re-adjusting. Experiment with different locations to find the one that provides the most relief.

6. Bird dog (leg lift/arm lift) Get on your hands and knees (four-point position—see Step 1) with your knees directly under your hips and your hands directly under your shoulders. Beginning with the “cat and dog” stretch is a good way to warm up for this exercise, and to find the “neutral spine” position to best perform the “bird dog” movement.

With your back in a neutral position (slightly arched), keep your eyes focused on a point on the ground slightly in front of your hands. Tighten your abdominals in an attempt to pull your belly button upward toward your spine and maintain this contraction while continuing to breathe. Then, extend one leg behind, without moving your back or pelvis (Step 2). Next, extend the opposite arm in front while keeping your balance. Try to grab something far away in front of you with your hand and touch an imaginary wall far behind you with your foot instead of just lifting it up (Step 3). Lower your leg and arm back to the floor and repeat with the other leg and the opposite arm. Repeat this motion for 12–15 repetitions per side, up to three (3) sets per side.

Note: This movement can be enhanced by extending both arm and opposite leg simultaneously, and then drawing them in (both at the same time) to a fully flexed position, attempting to touch knee to elbow.

Step 1

Step 2

Step 3

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The reality is that even the most ideal posture and movements needed for dentistry and working with children aren’t always healthy and natural for our bodies.

7. Dead bug Lie on your back and place both knees and hips bent to 90 degrees and both arms pointed straight towards the ceiling (Step 1). This should feel like the inverse of the “bird dog” position mentioned earlier. Activate your abdominals by bringing your belly button downward toward your spine. Maintain steady breathing while you lower one leg straight and lower the opposite arm behind your head (Step 2). Just before you touch the floor, return the leg and arm to the starting position and repeat with the other leg and opposite arm, maintaining the abdominal contraction throughout the entire movement.

Step 1

Step 2

Section 2 — Thoracic Spine Mobility Exercises

Step 1

Step 1

1. Prostrate prayer pose to cobra pose Start on all fours. Push your buttocks back toward your heels with your arms extended fully forward (Step 1). Then, transition into a cobra position by gradually moving your hips forward, keeping them close to the ground. Simultaneously raise your chest off the floor by pushing up with both arms to a fully extended position while keeping your legs flat on the floor surface (Step 2). Alternate between these two positions up to 15 times per session.

Step 2 Step 2

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2. Thoracic spine mobility with stick – Type 1 Start in a standing position and hold a stick in front of you with palms up and your feet a shoulder-width apart as illustrated (Step 1). Rotate your trunk to one side (twist body R or L), raising your hand (on the side to which you are rotating) high overhead while reaching the opposite hand across the body but keeping that arm parallel to the floor.

Do this while bending the trunk laterally to the side in the opposite direction of the raised hand (Step 2). Repeat the exercise, beginning this time by rotating (R or L) in the opposite direction as the first time. Perform this movement up to two (2) sets of 12 repetitions per session.

Note: trunk rotation and lateral bending are in opposite directions for this exercise.

Step11 Step

Step 22 Step

3. Thoracic spine mobility with stick – Type 2 Start in a standing position and hold a stick in front of you with palms up and your feet a shoulder-width apart as illustrated (Step 1). Rotate your trunk to one side (twist body R or L), lowering your hand fully on the side to which you are rotating while reaching the opposite hand across the body but keeping that arm parallel to the floor. Do this while bending the trunk laterally to the side in the same direction as the lowered hand (Step 2). Repeat the exercise, beginning this time by rotating (R or L) in the opposite direction as the first time. Perform this movement up to two (2) sets of 12 repetitions per session.

Note: trunk rotation and lateral bending are in the same direction for this exercise.

Step 1

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Step 2

Dentists are at risk for musculoskeletal disorders such as neck and back pain, in part due to the postural and biomechanical requirements of the profession. While it can be difficult to maintain proper ergonomics in all aspects of clinical dentistry, reminding ourselves and our staff of its importance and holding ourselves accountable for our wellbeing at work is likely to improve both the longevity and comfort of our practice. Improving workplace ergonomics can play an important factor in the prevention of these pathologies, such as setting up treatment rooms to allow for maintaining upright standing posture or ensuring that stool heights are at a level to achieve upright seated posture during patient care.

Ergonomic evaluations can be performed by licensed physical therapists for individualized evaluations of workspaces.

Beyond the clinic, regular participation in exercise to maintain core musculature strength and global spinal mobility can reduce the risk of overuse injury from faulty body mechanics in the workplace.

Achieving a balance of activity outside the office and an ergonomic workspace has been a personal and professional goal for both of us, and we hope that you can reap some of the benefits of finding a balance for yourself, wherever that may be.

together as part of a wellness program. By addressing and strengthening the areas listed above, we have focused on the prevention of chronic workplace injuries most commonly reported by dentists. This article provides a framework designed for dentists to combat workplace overuse injuries by creating weekly habits of customized exercises, improving ergonomics in the workplace, and encouraging participation in recreational activities.

It is not intended to treat any particular condition, and we encourage seeking the advice of a licensed physical therapist if you have any musculoskeletal conditions.

Remember, the exercises listed in this article are intended to be used

Most importantly—don’t forget to get out and enjoy regular physical activity! Increasing activity throughout the week and exercising some every day will significantly help to decrease the risk of injury associated with routine activity in the dental o ce.

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staying positive IN A WORLD ON LOCKDOWN—TWELVE WAYS TO CONTROL STRESS AND ENERGIZE YOUR LIFE

by Cathy Jameson, PhD

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ENERGY! IN TIMES THAT ARE TOUGH OR CRAZY—LIKE DURING THE COVID-19 EPIDEMIC—IT TAKES ENERGY TO HANDLE THE PROBLEMS OF THE WORLD, THE NATION, THE PRACTICE, AND EVEN YOUR OWN LIFE! DURING THIS PANDEMIC, EVERYONE FACES MULTIPLE STRESSORS—SUCH THINGS AS (1) SURVIVING FINANCIALLY, (2) STAYING HEALTHY, (3) STABILIZING AND REOPENING A PRACTICE, AND (4) MAINTAINING HAPPY, HEALTHY RELATIONSHIPS AT HOME DURING ISOLATION. YIKES, FACING THIS DAUNTING LIST, WE ARE BOUND TO FIND IT STRESSFUL! WHAT IS “STRESS?” Peter Hanson, MD, best-selling author and co-founder of the popular website at www.stressipedia.com, comments on stress this way. “Stress is neutral until it lands on a person. What that person has chosen to do about past stress and what the person chooses to do in response to present stress will determine the outcome.”

Stress can be invigorating and lead to the release of effective endorphins. However, when stress causes physiological or psychological problems, it’s termed “distress.” Distress is associated with 80 percent of all illnesses being treated today.

POSITIVE STRESS: Positive stress can be an effective motivator, a driving force. It can help you focus, perform, and get things done. You may perform well under pressure.

Then, it’s important to relax, “come down,” and celebrate the achievement. The relaxation following a stressful situation lets your mind and body recuperate, regenerate, and re-motivate.

NEGATIVE STRESS: Stress becomes negative when you stay at the “peak level” and don’t “come down.” If you don’t relax, breathe, and recuperate, then stress can turn into “distress.”

Stress cannot—nor do you want it to—be eliminated. Controlled?

Yes. You have the ability and the power to manage the stresses in your life so that you thrive from their natural energy.

twelve WAYS TO CONTROL 1.

Write out your mission, vision, and goals.

Focus on where you are now, where you are going—both personally and professionally—and how you intend to get there. Focus offsets chaos. Chaos without focus breeds stress.

A mission or purpose statement reflects who you are, what you do, and the importance of your work. It’s your “why.” A mission statement is built upon your unique and imperative values.

A vision is future-focused—where you are going. This clearly written map of your “ideal” practice becomes the impetus for making things happen. Set realistic goals. Positive thinking that is not supported by planned action is simply wishful thinking.

2.

Prioritize.

Prioritization will help you focus on the most important areas of the practice (or home life). Prioritization helps team members and the practice stay “on course” and not get lost in the busywork while falling short in the productive work.

3.

Time management.

Writing and prioritizing goals is one of the best timemanagement principles … ever! Study time management and put proven methods into action. (Send an e-mail to info@jamesonmanagement.com, and we will send you my e-book on time management.)

4.

Exercise on a regular basis.

During exercise, tranquilizing chemicals called endorphins are released into the brain. These naturally occurring chemicals bring about a pleasurable sensation.

Physicians who study the positive effects of exercise on the mind/body encourage a minimum of 30 minutes of vigorous exercise three to four times per week, with five times per week being even more effective.

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Include cardiovascular exercise in your program, along with strength training and stretching. This helps maintain strength and tone and will help a person to handle some of the challenging body positions maintained for long periods of time at the dental chair or at the computer.

Consult your physician before embarking on an exercise program. Consider hiring a professional to develop a program of exercise and fitness that is best suited for you.

5.

Practice proven relaxation techniques.

Relaxation techniques can reduce tardiness, absenteeism, illness, and can support greater individual productivity.

People often blame their jobs for uncontrolled stress. But remember, each person chooses how he or she will respond to or adapt to the stresses that are a part of modern-day dentistry. Be a good manager of your greatest gift and asset— you!

Here are some relaxation techniques you may find helpful: a. The Relaxation Response: Search for it on the internet at the Mind/Body Institute of Harvard Health—it works! b. Hobbies: Do something you really enjoy. Nurture a creative outlet that is totally different from the activities of your working day—whatever you like to do: sports, art, music, cooking, reading, or playing with your kids. c. Meditation: Forms of meditation are effective in reducing stress through the power of the mind and are not tied to any specific religious belief. Mindfulness. d. Visualization: Taking an imaginary trip from your past or a hoped-for trip of the future. Close your eyes, take a deep breath, and, for a few minutes, imagine the details of your dream location. Relax into a vacation-like state.

STRESS & ENERGIZE YOUR LIFE e. Music: Listen to music that is calming and peaceful to you. Sit quietly (if you can) for a few minutes and let the music soothe you. f. Massage: Schedule regular massages. These healthy sessions will relax the tension in your muscles and release toxins that accumulate in your body. g. Yoga: Yoga has the benefits of enhancing physical development, increasing flexibility, and fostering gentle relaxation. h. Sleep: At least seven hours per night are recommended for an adult.

Many other methods of relaxation are available. These are just a few examples.

6.

Feed your body properly.

"You are what you eat!" Eat a balanced diet: carbohydrates, protein and fat. Drink lots of pure water. Read and study the principles of good eating. (The internet makes this possible.)

In addition, work with an expert in nutrition to evaluate a program of supplementation that would be healthy for you.

Don't think that you can eliminate or control stress through the use of substances that may lead to dependence or abuse.

Moderate or eliminate your intake of alcohol, caffeine, nicotine, and barbiturates/tranquilizers.

7.

Feed your mind positively.

Feed your mind as carefully as you feed your body. Your subconscious mind doesn’t know the difference between reality and non-reality. So, when you pour “negative stuff” into your brain, it believes it. Be careful. “You become what you think about.” (Earl Nightingale)

Listen to healthy, stimulating music. Watch healthy movies and TV. Read constructive, motivational books. Surround yourself with positive people. Read something positive before you go to sleep. One sentence is fine. Put your mind to sleep on something positive.

Make a conscientious effort to overpower the influence of negativity. Make a decision to be positive. Look at the good things in your work, in your co-workers, and in yourself rather than looking for the bad. Expect the best. “Whatever the mind of man/woman can conceive and believe, so shall he/she achieve.” (Napoleon Hill) 8.

Stimulate your creative center.

Create mental fitness in the workplace. Continue to study the newest developments in your field. Adopt a positive approach by training the right side (the creative side) of your brain to actively seek and receive creative solutions.

Outside of the office, ask yourself, “What do I really love to do? What gives me ultimate joy?” Make a list of things that bring you joy and fulfillment. Then, as you organize your time, schedule these things into your life. Maximize your talent.

9.

Communicate effectively and face stressful situations head on.

Study and learn excellent communication skills—ones that will help you listen and speak more effectively to others.

Access the skill and knowledge of confrontation so that conflicts can be resolved constructively.

10. Organize every system within your practice.

Commit to getting and maintaining organization in your practice. Develop excellent management systems and have talented, well-trained people engineering those systems.

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health& p a i s e h pn s Monitor goals to make sure you are reaching those goals.

Adjust when necessary. Get a management coach in your life to analyze your practice and help you make sure it is “robust and fit.”

11. Eliminate the things in your life that are not working and focus on the things that are working.

The person who works at having a positive attitude and surrounds him/herself with positive people will always outshine the person who wallows in negativity, despair, and gloom. Be courageous enough to identify things that may have worked historically but are not working any more.

Change them.

Refuse to let negativity drain the very life from you. If you are the negative one, find out why—and change. Put a mirror up in front of your face. What you are receiving from others will be a direct reflection of what you are giving to them.

YOU MAY NOT BE IN PERFECT BALANCE NOW—PROBABLY NEVER WILL BE. HOWEVER, WORKING TOWARD THAT BALANCE IS WORTHWHILE IF STRESS CONTROL, HEALTH, WELL-BEING, AND JOY ARE IMPORTANT TO YOU. ARISTOTLE SAID THAT AT THE CENTER OF THIS “CROSS OF LIFE” IS WHAT ALL HUMAN BEINGS ARE SEEKING— HAPPINESS.

The key to stress management is control. Learn to ignore what you can’t control, and learn to control what you can. All of life is a matter of choice. Remember: you are the manager of your own self. Choose healthfully and wisely.

12. Strive for a balance in your life—a balance of work, love, worship, and play.

Aristotle called this the “cross of life” and believed that all people are striving for a balance between these four elements. He said that if a person is feeling “out of balance,” one of these critical areas of life fulfillment is probably not getting the time, attention, or nurturing that it needs.

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and thrive.v

WE’RE GOING

GREENER.

Introducing compostable, plant-based packaging.

Learn about our ongoing, eco-friendly efforts at: sprigusa.com/sustainability

GETTING READY FOR A COMEBACK How Do I Bring “People” Back to My Practice?

by Paul Edwards

T

hroughout the current COVID-19 health crisis and resulting lockdown, practice owners across the nation and around the world have been stuck at home watching the news and waiting. You’re waiting for legislative and financial relief, for the curve to flatten, and, above all, for the day when you will be given the green light to return to work and start accepting patients again.

I’m here to tell you that day will indeed come. But when it does, it will probably not be a return to business as usual. A historical line has been drawn and, moving forward, we will speak of the time before the novel coronavirus swept the globe, and the time after, when things finally began to settle back into a new normal.

By now you’re probably starting to think about bringing people back to your practice. And, as you start planning to get yourself and your team back to work, there are a few things you’ll want to keep in mind.

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Number one is this. As an owner of a pediatric dental practice, “people” to you means more than just your patients and employees. Since your patients are minor children, you’ll also need to add your patients’ parents to your safety equation.

EVERYONE WILL NEED TO FEEL CONFIDENT THAT RETURNING IS SAFE. In order to successfully bring anyone back to your practice, your employees and your patients’ parents are going to need to know that it is safe for them to be there. To get things started, the first component of that process involves developing a protocol for transparent communication.

Oddly enough, for the first time in my 16 years of advising dental practices on human resources issues, the safety of both patients and employees is intersecting in a way that I never could have imagined. In the days after the COVID-19 curve is flattened, the safety of your patients and the safety of your employees will be one and the same.

Social distancing works by limiting the number of contacts people have with one another. As we have all seen, even grocery stores and gas stations are taking steps to create as much distance between employees and customers as possible. This is going to be the new normal.

Pediatric dentists, in particular, are going to face some of the most complex challenges. That’s because in many of the pediatric practices we work with, the patient load is typically 60 or more kids per day. That was challenging enough on a normal day before the pandemic. With all that in mind, it’s clear to see that new, stricter

protocols for handling patients will be imperative moving forward.

Pediatric practices also tend to have more—not fewer— ancillary support staff in both clinical and nonclinical positions. Every day you open the office, you create a mini village!

While I won’t go into the nuts and bolts of everything you can do to protect your patients and your team from a practical perspective, here are some of the ideas I’m hearing from CEDR’s 2,000 member dentists and the 7,000 dental and medical professionals who make up our private Facebook Group, HR Base Camp.

• • • • • • • • •

• • •

Provide a gown and mask for every patient.

Have patients wait in their cars instead of in the waiting room.

Bring patients directly to operatories instead of allowing them to wait in the lobby.

Make sure all paperwork is filled out digitally prior to every visit.

Limit contact with and between dentists, hygienists, and assistants.

Have non-clinical staff sequestered behind a plexiglass barrier.

Reserve one bathroom strictly for employee use.

Have non-clinical staff work more remote hours whenever possible.

Expand hours so you can see the same number of patients while allowing for much larger breaks between patients in order to sanitize operatories.

Prop doors open so patients and employees do not have to touch them.

Ask patients to wear gloves prior to entering.

Take all patients’ temperatures before seeing them (especially kids).

One doctor I spoke with even plans to fire up a TV screen in order to communicate with his non-clinical staff via video feed.

Not all of these things will be right for your practice, of course. And I recognize that many of these options present their own challenges. Still, I decided to provide this list because I think the concepts serve us well as we talk about returning our teams to the office and keeping the workplace safe for them and your patients.

However, you elect to mitigate risk at your practice, everything you do will have an employee component, and that’s where HR kicks in.

Ever since it became apparent that the COVID-19 pandemic might establish itself in the US, our Solution Center started receiving questions from members about how the spread of the disease would affect their practices and employees.

At first, those questions were largely about instituting temporary office closures. Now employers are starting to ask about the process of bringing people back to the office. In this section, I’ll go over the process of reopening by answering some of the most common questions we’re getting from employers about this topic.

BRINGING YOUR TEAM

BACK TO WORK

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Q&A 1. Can I have my employees sign something that says they assume the risk of coming to work and hold me blameless?

The answer is “No.” In fact, that kind of signoff could be used to prove that you knew the workplace was likely unsafe and yet continued to require employees to show up. Our guidance here is that you do everything you can to stay abreast of and follow the guidelines for treatment protocols as set forth by the CDC, OSHA, your governing body, and all federal and state authorities, while also staying on top of your workman’s comp carrier’s latest guidance.

If your governor or anyone else in a place of authority says, “Emergencies Only,” then follow that guidance. If they say, “Close,” then close. But, most importantly, document your efforts to comply with the rules.

CEDR members have access to HR software that allows them to distribute new training and guidance to employees in the form of digital memos. Employees can also sign off on those documents online.

Go over any concerns from your team each morning before opening and document what you did to address those issues. You’ll want to be able to show that you are constantly learning and updating your team’s knowledge when it comes to addressing safety in the workplace. OSHA requires you to maintain a safe and healthy workplace —your employees cannot release you from that responsibility.

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2. Can I require my employees to self-report if they or a family member have symptoms of the virus or have come into close contact with someone who has the virus?

Yes, you can and should ask your employees to self-report any symptoms of the virus, i.e. fever, chills, cough, sore throat or shortness of breath that they or a family member have. If you witness an employee with these symptoms, you should separate the employee immediately from your staff and send her/him home.

You should also ask your employees to self-report if they come into close contact with someone confirmed to have the virus. Follow CDC guidance on when to allow these employees to come back to work. Most importantly, you’ll need to immediately document what you did in the employee’s file.

3. If one of my

employees is confirmed to have the virus, how do I report this to my other employees? Do I have to shut down, too? Do I have to notify patients?

According to the CDC, if an employee is confirmed to have COVID-19, “employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). The employer should instruct fellow employees about how to proceed based on the CDC Public Health Recommendations for Community-Related Exposure.”

According to the American Dental Association, if an employee or patient is confirmed to have COVID-19, “The local Department of Health may contact the Dental Practice and direct proper precautions. Expect that the

dental practice will need to close, that some or all of the staff will need to be advised of the possibility of infection.

Employees who were in contact with the infected employee or patient will likely need to stay at home for the 14day incubation period, and the Dental Practice will likely need to be closed for a period of time to conduct a deep cleaning. The name of the infected employee or patient should not be disclosed to other employees or patients due to numerous state and federal confidentiality and privacy laws.”

To avoid the risk of exposure to both employees and patients in the office, make sure to read and follow ADA Interim Guidance for Minimizing Risk of COVID-19 Transmission.

4. Do I have to have

them fill out an application?

No, if this is a returning employee there is no need for you to have them fill out an application.

5. What about a W-2?

Yes, out of an abundance of caution, we recommend that you have them fill out the W-2. The law reads that a new employee must provide the information. While they are not really new, technically they are coming back to start work. If you used the word “furlough” rather than “layoff” in your notice letter a few weeks ago, you do not need to collect the W-2 information again.

THE NAME OF THE INFECTED EMPLOYEE OR PATIENT SHOULD NOT BE DISCLOSED TO OTHER EMPLOYEES OR PATIENTS.

YOU’LL WANT TO BE ABLE TO SHOW THAT YOU ARE

CONSTANTLY LEARNING

and updating your team’s knowledge when it comes to addressing safety in the workplace.

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6. Do I need to worry about new hire reporting?

Yes, if you are required to do so, you will want to comply with reporting. In most instances, your payroll company is supposed to take care of this for you.

7. Do returning employees go immediately back on benefits (PTO—Paid Time Off ) or are they like new employees with a new waiting period?

In general, employers have a lot of discretion when it comes to vacation benefits. Whether or not you reinstate vacation benefits to returning employees will depend on a variety of factors, including: (1) whether you laid employees off or just temporarily furloughed them, (2) what your written policies say about this, (3) whether you can afford to maintain your discretionary paid time off benefits when you reopen.

If you temporarily furloughed employees, you will likely want to honor any vacation that was earned prior to your closure, but you can suspend accrual moving forward until you can afford to reinstate your policy in full again.

You could also explain (in writing) that employees will not be able to use their vacation benefits for the next couple of months or until further notice while the office re-establishes itself.

If you cannot afford to reinstate previously earned vacation, then make sure to check your state laws before you void these benefits as some states treat vacation as earned wages.

If you laid employees off (i.e. officially terminated employment), then you could technically require employees to start from zero in terms of eligibility for vacation benefits, just

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like any other new employee (unless your written policies say otherwise).

This isn’t necessarily advisable for obvious reasons related to team morale.

the new laws, which are in effect until December 31.

We would recommend reinstating any previously earned vacation that wasn’t paid out upon separation, or at least making these employees immediately eligible for any vacation benefits under your policies. When it comes to mandated paid sick leave benefits, make sure to follow any state or local laws in place because they will likely require reinstatement.

We are advising our members to be cautious about using the opportunity to eliminate a person as a method for getting rid of an employee you don’t want to rehire. If you don’t need to bring someone back, then that is fine.

But, if you say that you don’t need them and then fill the position with someone else, that could be seen as a violation of specific job protections that are built into the FMLA.

In any case, make sure to clarify any changes to benefits in writing from the start with your returning employees to avoid any misunderstandings.

8. Do I need a policy about reporting illnesses?

Yes, as we alluded to earlier, you will need to distribute a new policy regarding reporting. You will also need to add several other policies and post notices regarding the new laws, which are in effect until December 31.

9. Can I change hours, pay rate, and job duties?

Yes, you can run your business in the manner that you need to in order to open back up and get back on your feet. This could include reduced hours, benefits, and changes in job duties. However, note that you are now subject to new laws under the Family and Medical Leave Act (FMLA).

Likewise, if you are participating in a Paycheck Protection Program—Small Business Administration (PPP SBA) loan, there are specific rules regarding pay and benefits with which you must comply. as we alluded to earlier, you will need to distribute a new policy regarding reporting. You will also need to add several other policies and post notices regarding

10. What if I don’t want to bring someone back?

Follow this rule: If you had 10 employees before you furloughed your staff, then try your best to bring the same 10 back. If you had 10 when this all started and your business only needs eight for the foreseeable future, then make sure you don’t lean on any discriminatory criteria when it comes to choosing the eight you’ll keep.

A SHORT LIST OF THINGS TO DO. 1. Provide an offer letter to return to work that communicates hours and expected timelines.

2. Collect W-2 information.

3. Have employees sign your employee handbook after updating any policies that need to be updated. It has never been more important that you make sure that your employee handbook is legal and up-to -date.

4. Make employees aware of new legal requirements for posting benefits available under the Families First Coronavirus Response Act. 5. If you have been paying for their portion of health insurance, you will need to make arrangements to start collecting the payments you’ve been making on their behalf.

Note that you cannot collect it all at once, and that there are wage and hour laws that you must comply with if you work out an automatic deduction from their paychecks.

WE KNOW THAT THIS IS ALL

PRETTY DAUNTING;

and, honestly, there will still be a few t’s le t uncrossed and i’s undo ed even if you follow the guidance in this article to the le er.

Help is Available Still, there are three ways that we at CEDR can help you with this process which cost nothing. I encourage you to use all three.

1.

Visit our coronavirus resource page for employers at cedrsolutions.com/healthcare/ employer-coronavirus-guide/.

We are updating the guidance on that page and adding additional resources and answers to FAQs almost daily.

2.

Join over 7,000 other dental and healthcare employers in our private Facebook group, HR Base Camp. Our group members have proven very helpful and informative over the past few weeks. I’m also online answering questions personally on a regular basis.

3.

Sign up for free access to our HR Vault software. We are waving both the monthly and

start-up fees for our basic software package. This will allow you to execute everything we’ve described here, including sharing digital documents, collecting employee signatures online, and even including access to On-Demand HIPAA Training for your entire team. Unlock your HR Vault at cedrsolutions.com/hrvault.

Make no mistake—we are at a crossroads right now. Ge ing back to business does not necessarily mean ge ing back to business as usual. But with a li le bit of planning and some help from the pros, you’ll be ahead of the curve when it comes to relaunching your practice. You’ll also be ahead of your competition. sp r ig u sa.co m / S p r i n g 2 02 0

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REST LESS

SLEEP

Pediatric airway questions relating to obstructive sleep apnea in children.

by T. J. O-Lee, MD

Issues dealing with the growing pediatric airway are nothing new to dentistry. Bruxism, snoring, and even chronic allergies are conditions that deserve additional understanding if pediatric dentists are to be able to treat their patients the best way possible. In this article, four pediatric dentists ask Dr. T.J. O-Lee, chief of pediatric ENT at Loma Linda University, questions about the pediatric airway. His answers provide medical insight for pediatric dentists that help us construct a more complete picture of the complexities associated with the airways of our smallest patients.

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T HE SIZE OF THE CHILD DOES NOT NECESSARILY CORRELATE WITH THE VOLUME OR FEROCITY OF THEIR SNORING. Obstructive Sleep Apnea (OSA) Paul Johnson, DDS—CALIFORNIA

QUESTION: I’ve been asked, what percentage of children actually have obstructive sleep apnea (OSA) and need any treatment? What does science show about the actual impact of obstructed airways and how does this condition affect oral dental health?

What about OSA in kids that have a lot of neck weight, diagnosis of ADD/ADHD, and huge tonsils? Do ENT specialists provide some general guidelines for answering the following questions: 1) what constitutes a treatable OSA condition in kids, 2) how do ENTs assess tonsils, and 3) when should tonsils be removed, or should they?

ANSWER: Childhood snoring puzzles many parents. They often complain, “Such a small body should not produce that kind of noise all through the night.” I have viewed enough parent-provided video clips to attest that the size of the child does not necessarily correlate with the volume or 66

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ferocity of their snoring. While snoring is annoying, it rarely requires medical treatment. It is, however, an indicator of a more serious condition—Obstructive sleep apnea (OSA).

OSA occurs in approximately 3–5 percent of the pediatric population. Its symptoms include snoring, mouth breathing, gasping / choking during sleep, daytime hyperactivity, behavioral / learning difficulty, and daytime fatigue.

While it is commonly expected that a fatigued child would be sleepy, such expectation is often unrealized due to fatigue-associated hyperactivity in young children. One useful diagnostic question I have come to depend on is this, “Does your child fall asleep in the car?” The car seat restrains the child and disables fatigue-induced hyperactivity long enough to allow the sleepy child to finally emerge.

If more objective evidence is needed, the gold standard for OSA diagnosis is the overnight sleep study, aka polysomnogram (PSG). This test measures many sleeprelated parameters and provides a series of numerical values to assess the presence / severity of OSA. These numbers are useful in many clinical situations, including the assessment of interventional efficacy. Although OSA can often be diagnosed by clinical symptoms, PSG can be helpful when parental observations lack certainty.

Adenotonsillar hypertrophy is by far the most common etiology for pediatric OSA. While it is tempting to classify the severity of OSA according to tonsil size, studies have shown that it is possible for impressive-sized tonsils not to be associated with OSA. Also, children with relatively small tonsils may suffer from OSA due to adenoid hypertrophy.

While large tonsils do more frequently lead to OSA, clinical symptoms are much better predictors of OSA than tonsil size alone. Therefore, it is prudent to follow up any observation of large tonsils by asking parents a few questions regarding their child’s symptoms. “Does your child snore?” “Is she hyperactive throughout the day?”

“Does he fall asleep when you drive around town?” These questions may prove helpful in uncovering potential cases of OSA. In the ENT world, tonsils are assigned a grade from 1 to 4.

Each number approximates 25 percent of the available oropharyngeal space. If tonsils occupy approximately 60 percent of the available space, then they are grade 3. An alternative way to grade tonsils takes into account the relationship of the tonsils to the surrounding structures. If tonsils reside completely inside the tonsillar fossa, then they are grade 1. Grade 2 tonsils extend beyond the tonsillar fossa but do not touch the uvula. Grade 3 tonsils touch the uvula.

Grade 4 tonsils touch each other.

Mouth breathing is a common symptom for kids with OSA. Enlarged adenoids can obstruct the nasal passage necessitating opening the mouth to increase air flow.

Prolonged mouth breathing throughout the night can dry the oral cavity and decrease saliva lubrication. This has been theorized to increase the rate of dental caries and cause adverse effects for oral health.

Tonsillectomy and adenoidectomy surgery (T&A) is one of the most commonly performed surgical procedures in the world. Approximately 500,000 cases are performed in the United States annually. It is the first line of therapy for pediatric OSA. The surgical success rate for T&A against pediatric OSA is around 80 percent. While CPAP (continuous positive airway pressure) is often recommended

for OSA treatment in adults, the higher success rate of T&A in pediatric patients makes surgery more desirable than CPAP. CPAP is often poorly tolerated in the pediatric population and has been known to affect mid-face protrusion over time.

Tonsil Size

Scoring Source: https:// sleepmedicineboardreview. wordpress.com/2011/10/25/ tonsil-size-scoring/

For patients with clinical signs of OSA and enlarged tonsils, PSG may be optional. When the clinical picture is unclear, results of PSG may be helpful in guiding treatment decisions. Since even mild cases of OSA can be disruptive to a child’s learning and quality of life, treatment should be considered as early as possible.

Treating an Inadequate Airway Joelle Speed, DDS—CALIFORNIA

0 Surgically removed tonsils

1 Tonsils hidden within tonsil pillars

QUESTION:

2 Tonsils extending to the pillars

Biological dentists have been discussing among themselves whether it is possible to “grow” an inadequate airway. Have you heard of this, and is this possible? Also, some dentists have suggested that early orthodontic expansion may help with resolving airway issues. Is that true?

ANSWER:

Time has always been a friend to airway surgeons. Many conditions, such as laryngomalacia, nasal stenosis, or tracheal stenosis, can improve as the size of the airway increases with growth. One of the last-resort interventions for a neonatal airway problem is to perform a tracheostomy.

The principal behind the tracheostomy is to provide an alternate airway to allow additional time for growth. For many children, tracheostomy can be removed within the first two years of life.

3 Tonsils are beyond the pillars

Anatomy of

4 Tonsils extend to midline

OSA

Growth affects all aspects of the airway, but is most pronounced at its narrowest points, such as the nasal passage and the larynx. The equation for laminar flow resistance (Q) in a tube is equal to R4/ 8 L (R=radius of the tube, =viscosity of the fluid, and L= length of the tube). As you can see, the flow resistance in a tube is inversely affected by the radius of the tube to the fourth power. This means even a small increase in the size of the airway can lead to a significant drop in airway resistance. The size of the child increases by several fold in the first two years of life; therefore, improvements in airway patency are often observed as well. The most critical period of anatomical airway resistance is within the first couple years of life.

I personally do not have much experience in orthodontic expansion treatment of airways, but such expansion would likely have to be instituted early to make any significant impact.

“ TIME HAS ALWAYS BEEN A FRIEND TO AIRWAY SURGEONS.” sp r ig u sa.co m / S p r i n g 2 02 0

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Bruxism and Problems with Grinding Mandy Ashley, DMD—KENTUCKY

QUESTION 1:

Parents ask me all the time about grinding in preschool and elementary age children. Typically, I do not recommend anything other than warm compresses and TMJ massage by the parent as part of a child’s bedtime routine. An exception is when cases of grinding are associated with GERD. In those cases, we sometimes have to get invasive and go with full-coverage options such as using zirconia or stainless steel crowns to stop extreme sensitivity and allow the kids to eat. I’m typically not in favor of any “night/ bite-guard” type of appliance in growing kids, but I want to make sure we’re not missing something.

Andi Igowsky, DDS—WISCONSIN

QUESTION 2:

The number one question we get in our office from parents is about grinding. I personally believe that it is 100 percent related to airway and allergies. I’d love to know if that is what ENT specialists believe. And since we can’t really treat grinding in little kids, what do they think about treating the airway first? What about things like using nasal spray before bed all the way to the extreme of performing a T&A—removing tonsils and adenoids?

ANSWER:

Nighttime teeth grinding or sleep bruxism occurs in up to 30 percent of children. There is an age-related prevalence distribution that seems to peak around age 6. Prevalence tends to decline when children are around 9- to 10-yearsold. While the exact cause of the condition is unclear, some degree of bruxism may be considered physiologic and promotes normal growth of the facial skeleton. For this reason, sleep bruxism itself does not require intervention.

Problems with bruxism arise when children start to experience adverse effects such as pain, excessive dental wear, or sleep disturbances. Some authors advocate treatment for bruxism in children over the age of 10, when physiologic bruxism starts to decrease.

A meta-analysis of childhood bruxism treatment in December 2019 by Chisini, et al, summarized the effectiveness of many forms of treatment. The use of nighttime occlusal splints decreases parent-reported bruxism by 77 percent and improves conditions such as headache and muscle discomfort. Physical therapy also provided similar benefits. Pharmacologic agents such as Flurazepam, Trazadone, and Hydroxyzine have been shown to reduce bruxism and morning pain. Palatal expansion using rapid maxillary expansion devices for six to eight months reduced bruxism in 58 percent of children.

Some people hypothesize that sleep bruxism can be triggered by OSA. It is postulated that the unconscious effort to keep one’s airway patent can lead to an increase in autonomic drive. This contributes to the stimulation of upper airway muscles. This increased drive can then be a trigger for muscles of mastication and cause bruxism.

While sleep bruxism is not considered to be a condition requiring airway surgery, any improvement in bruxism from treatment of OSA is certainly welcomed. It is, therefore, reasonable to inquire about symptoms of OSA when

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questions arise about bruxism. Asking airway screening questions in the pediatric dental office is likely to be very helpful in the diagnosis and treatment of OSA. Simple questions about snoring, nighttime awakening, hyperactive behavior, or daytime somnolence can increase parental awareness about OSA. Symptomatic children should be referred to their primary care provider for further evaluations (such as PSG) or treatment (possible ENT referral). More conservative measures to improve airway patency such as allergy treatment and nasal steroids should also be considered in patients suffering from chronic sneezing, nasal drainage, or watery eyes.

Conclusion Care of the pediatric airway and oral health are intimately related. Pediatric dentists are well positioned to screen for OSA and other airway problems due to the frequent opportunity they have of observing their patients’ oral anatomy. Many of the signs and symptoms for OSA are subtle, and parents may tend to overlook them. But a vigilant pediatric dentist who observes signs like tonsil hypertrophy and mouth breathing may assist ENT colleagues in the identification of airway problems. Asking screening questions about snoring, nighttime awakening, daytime hyperactivity, and sleepiness during car trips can elicit further clues about a child’s nighttime sleep quality. By working together, pediatric dentists and pediatric otolaryngologists can significantly improve the breathing quality of our youngest patients.

References Bellerive A, et al. The effect of rapid palatal expansion on sleep bruxism in children. Sleep and Breathing 2015;19,4:1265– 1271. doi:10.1007/s11325-015-1156-4.

Chisini L, et al. Interventions to reduce bruxism in children and adolescents: a systematic scoping review and critical reflection. Eur J Pediatr 2019;179,2;177–189. doi:10.1007/ s00431-019-03549-8.

Khademian M, et al. The efficacy of low and moderate dosage of diazepam on sleep bruxism in children: a randomized placebo-controlled clinical trial. J Res Med Sci 2019;24,1:8. doi:10.4103/jrms.jrms_131_18.

Machado E, et al. Prevalence of sleep bruxism in children: a systematic review. Dental Press J Orthod 2014;19,6:54–61. doi: 10.1590/2176-9451.19.6.054-061.oar.

Manfredini D, et al. Prevalence of sleep bruxism in children: a systematic review of the literature. J Oral Rehabil 2013;40,8:631–42. doi:10.1111/joor.12069.

Oliveira M, et al. Bruxism in children: effectiveness of bite splints. J Dent Res 2014;2,1:22. doi:10.19177/jrd.v2e1201422-29.

Reimão R, et al. Evaluation of flurazepam and placebo on sleep disorders in childhood. Arq Neuropsiquiatr (Archives of Neuropsychiatry) 1982;40,1:1–13. doi:10.1590/ s0004-282x1982000100001.

Tachibana M, et al. Associations of sleep bruxism with age, sleep apnea, and daytime problematic behaviors in children.

Oral Dis 2016;22,6:557–565. doi:10.1111/odi.12492.

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Brenda Hansen: Sprig’s CEO shares some thoughts during a phone interview for Shift magazine.

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Doing It Right— Sprig Celebrates 10 Years Based on an interview with Brenda Hansen, Sprig CEO

by Mary Ellen Kilpatrick

IN

a world that looks starkly different than it did mere months ago, Sprig Oral Health Technologies, Inc.—pediatric dentistry’s leading technology and clinical education company—is marking an important milestone.

The company sold its first crowns (the firstever pediatric Zirconia dental crowns) 10 years ago in September 2010. Over the course of a decade, Sprig proceeded to disrupt the pediatric dentistry industry; build a global business; consistently add to its portfolio of products; provide continuing education programs for dentists and their teams; publish a meaningful, accessible magazine; and this year, launch a pediatric dentistry podcast. sp r ig u sa.co m / S p r i n g 2 02 0

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IN

February 2020, about a month before the COVID-19 crisis began to require United States nonessential businesses to close and travel to halt, Sprig CEO Brenda Hansen and several of her team members were in Dubai, sharing their products at the UAE International Dental Conference and Arab Dental Exhibition (AEEDC–Dubai), the Middle East’s largest dental conference and one of the largest dental events in the world.

“We were impressed,” Hansen commented. “It was great to see the clinics, training, and the level of patient demand for healthy biocompatible products.”

Innovation in a time of crisis

2006 EZPEDO—Dr. John Hansen and Dr. Je rey Fisher make the decision to found EZPEDO, Inc. and develop the world’s first pediatric Zirconia crown.

2007 First prototypes of pediatric Zirconia crowns are engineered and produced in Dr. Hansen’s cosmetic dental laboratory.

2008

One month later, Hansen and her administrative team closed the Sprig office in compliance with national guidelines. And yet, the climate of uncertainty brought forth by the ongoing global pandemic was one that Sprig is decidedly equipped to endure.

First Use—An EZPEDO Zirconia crown is seated on a pediatric patient for the first time.

For starters, it only makes sense that a company founded on an industry-disrupting technology would foster a culture of innovation and flexibility. Innovation is one of the major defining characteristics adopted during Sprig’s 2016 rebranding process.

Faced with the current coronavirus crisis, Sprig also has placed an additional emphasis on financial stability, planning, back-up planning, and a willingness to pivot as key principles to guide them through unprecedented territory and into the future.

“Every day I’ve been waking up to a puzzle of how best to get our team back to work,” Hansen observed.

2009 Zir-Lock Launched— Zir-Lock retention feature with internal mechanical grooves is developed to dramatically improve clinical longevity.

Since the pandemic’s onset, Sprig has opted to take all product sales and distribution back in-house, after having partially outsourced these services through Henry Schein Dental, a leading global dental distribution company. Hansen expressed her gratitude for the recently terminated partnership.

2010 Website Launched— Space-Loss sized first molars are developed, the ezpedo.com website is launched, and Zirconia crowns are first o ered for sale to pediatric dentists.

“We learned so much, and it made us a better, stronger company,” she reflected.

The company has also recalibrated its newly launched Sprig Podcast to better serve the dentists in their audience.

“We had an extensive library of podcasts prerecorded and ready to be released, but about two weeks before the pandemic really hit, we switched gears and produced four different podcasts that are centered around the needs of dentists during the pandemic,” Hansen recalled. “I worked at a dental office for 20 years, so I know that many doctors do not have the luxury of access to an HR department or an accounting department. Through our podcasts, we have tried to give them the human resources support and financial information that is relevant to their practices at this time.”

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2011 Relaxed Undercuts— EZ-Seat contour modifications are made to the occlusal profile and relaxed undercuts are introduced.

2012 Glazed and Polished— Zir-Plus hybrid surface treatment developed with a synergistic use of glaze and polish for a nearly flawless combination of visual aesthetics and occlusal function.

2013 EZPEDO University— Zir-Lock Ultra is introduced with the added benefits of Margin Lock. A design patent is granted for the Zir-Lock retention feature. EZPEDO University—dentistry’s premier, hands-on, over-the-shoulder instructional program in the use of pediatric Zirconia crowns—is launched.

Doing It Right— The Early to Years the Present 2017

2014

Rebrand Launched— EZPEDO rebrands to Sprig Oral Health Technologies, Inc. EZPEDO patents key crown features. Sprig introduces HemeRx, the first hemostatic agent for pediatrics, and SmartMTA, the first fast-set MTA for bioregenerative pulp therapy.

Modified Contours— Second generation Posterior V2 crowns with Flat-Fit modified contours are introduced, requiring less tooth prep.

2018 Henry Schein Dental Partnership— Sprig Oral Health Technologies, Inc. partnered with Henry Schein Dental, bringing customers the ability to receive on-the-ground support, as well as the convenience of ordering our products through the Henry Schein online catalog.

2015 EZPEDO Magazine Launched— A bi-annual magazine highlighting relevant topics of interest for busy practitioners in private practice.

2019 2016 Rebrand Started— Siegelvision, an organizational identity consultancy in New York, is hired to initiate the process of repositioning EZPEDO as a next-generation, oral health technology company.

MDSAP Certification— Sprig Oral Health Technologies, Inc. received it’s MDSAP and European CE certificates, opening up direct shipment options to international customers.

2020 The Sprig Podcast

The Sprig Podcast launched amid the COVID-19 pandemic.

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Refining a vision for the future Hansen said the recent health crisis has reinforced and brought clarity to some of Sprig’s long-held convictions and future plans. “Over the next year,” Hansen added, “Sprig will be rolling out a series of environmentally friendly initiatives to increase our sustainability practices. We’ll begin by introducing plant-based packaging for our refill products.”

“Confronted with COVID-19, we're seeing the world slow down,” Hansen noted. “I think one of the things we all need to emphasize a little bit more is taking care of our planet so that it will take care of us.”

In addition to increased sustainability, the company is poised to increase its philanthropic efforts, provide more options for in-office product demonstrations, and enhance its educational offerings based on the needs of the market.

Naturally, given Sprig’s history and its emphasis on the team’s in-house research and development, a commitment to continue developing new, innovative products for pediatric dentistry is also high on Hansen’s list.

She also expects the company will continue to expand globally, particularly having recently received certification through the Medical Device Single Audit Program (MDSAP) —an international regulatory process developed by representatives of Australia, Brazil, Canada, and the United States. Sprig’s MDSAP approval demonstrates the company currently meets or exceeds the strictest global regulatory standards in the industry.

Importance of team e ort When she talked about the future, Hansen spoke confidently and with a level of trust that her vision will be realized. When asked, she quickly explained that her confidence is rooted in Sprig’s team of about 40 employees, all based near Sacramento, California.

“It’s impossible to reflect on the journey Sprig began a decade ago and my personal journey without acknowledging the impact of having a talented team on board,” Hansen reminisced. “It’s a beautiful thing. Many people have been with the company for a very long time, enabling us to create a close family atmosphere.”

So important is the Sprig team to Hansen that she cited her first human resources hire, Gwen Pisenti, as one of the most important milestones of the decade. The addition of Pisenti helped build an infrastructure to support growth, shaping the team that Sprig is blessed with today.

“We were ready to grow and Gwen helped Sprig make sure we could do it right,” Hansen concluded.

Doing it right is a phrase that Hansen referred to frequently.

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of Sprig at-a-glance

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Countries Sprig does business in

1,000,000+ Crowns sold in the last 10 years

9

Pediatric products sold by Sprig

Employees working for Sprig

11

41

Issues of Shift magazine published

900+

Dentists trained at Sprig University

“It’s one thing to say it, but the proof is in our actions,” she emphasized. “Doing it right is not only about earning the trust of our customers, patients, and end users. During this pandemic, it’s about our team trusting us to make the right decisions to keep the ship afloat, and then positioning ourselves to get back to a new normal. There will always be opportunities to cut corners, but we choose to do it right. We must stick to our core values—honesty, integrity, respect, continuous improvement, teamwork, and gratitude. We value the support of each customer, employee, and team member as we celebrate our first 10 years of success.”

Sprig’s CEO: Working to make sure Sprig’s next 10 years are even better than its first.

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HERE’S TO 10 YEARS Thank you for letting Sprig assist you in changing the lives of so many children over the last 10 years.

Together we have changed the face of pediatric dentistry,

Forever.

A LOOK BEHIND THE SCENE True leaders create their own content and that’s exactly what we do at Sprig. So remember, the beautiful pictures of smiling children in all our ads are not stock photos, they’re all special because they’re all patients wearing EZCrowns.