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Products to Watch The best products for your practice in 2018


Tetric Evo Line ®

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Using curing light with an intensity ≥1,000 mw/cm . Data on file © 2018 Ivoclar Vivadent, Inc. Ivoclar Vivadent, Ivocerin, Adhese, Tetric EvoFlow and Tetric EvoCeram are trademarks of Ivoclar Vivadent, Inc. 1 3


< – 4 mm

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January/February . 2018

From The Publisher

Modernization.............................................................. 4

A Look Ahead to ADSO’s 2018 Annual Summit....... 6 Championing Hygiene in 2018...... 8 2018: What to Expect...........................10 Products to Watch

The best products for your practice in 2018.......20 Ivoclar Vivadent Crosstex®/Accutron™ Hu-Friedy VOCO Isolite KaVoTM ELECTROmaticTM System NSK Zirc Tuttnauer Preventive Technologies, Inc. (Preventech) Hager Worldwide

Nitrous Oxide and Oxygen Sedation More dentists are finding that nitrous oxide leads to enhanced patient satisfaction, efficiency and revenues.........................36

Piped vs Portables

Piped nitrous oxide systems often offer the best solution – provided they are properly installed.......39

Respiratory hygiene and cough etiquette in the dental practice......42

p10 Efficiency In Group Practice is published six times a year by Share Moving Media • 1735 N. Brown Rd. Ste. 140 Lawrenceville, GA 30043-8153 Phone: 770-263-5257 • Fax: 770-236-8023


Jack Allen, national purchasing director, Great Expressions Dental Centers. DeAnn McClain, vice president of operations, Heartland Dental. Lorie Streeter, FAADOM, CTC, chief operating officer, American Association of Dental Office Managers.

OSAP: An education resource for you and your group practice

Training opportunities, resources, compliance checklists and toolkits........................46

Industry News...........................................48 EDITOR Laura Thill •

PUBLISHER Bill Neumann

MANAGING EDITOR Graham Garrison • ASSOCIATE EDITOR Alan Cherry • CIRCULATION Laura Gantert • ART DIRECTOR Brent Cashman •



Efficiency In Group Practice is published six times a year by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2018 by Share Moving Media All rights reserved. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publishers. Publishers cannot accept responsibility for the correctness of an opinion expressed by contributing authors.

ISSUE 1 • 2018 :


From the Publisher

Modernization This is a wonderful time of year to recharge, reflect and evaluate the opportunities and challenges that await us in the new year. We’ve reached out to several key executives from dental support organizations and their industry partners to get a sense of what they are focused on for 2018. In our Dental Forecast article, there is a common point that each contributor focuses on – technology. Technology is a part of a broader category, which we have termed ‘modernization.’ One could interpret the terms ‘technology’ and ‘modernization’ as interchangeable terms, or ‘technology’ could be considered just one way to ‘modernize.’ Either way, it is something that every business needs to constantly evaluate, accept, and embrace. Dr. AJ Acierno, Founder of DecisionOne Dental Partners, talks about the use of technology in making dental practices more efficient. His perspective on efficiency is not about saving money, or being able to see more patients in a single day, but about the patient experience itself. Creating efficiency should be for the benefit of the patient. Patients don’t want long waits or extended dental procedures. Using technology in order to efficiently and effectively provide the best patient outcomes and experiences is one of the keys to successful modernization. Greg Nodland, President and COO of Great Expressions, talks about the modernization of their staff training program, GEDCU, the addition of free wi-fi to each office, and their continued market-leading use of social media. Great Expressions uses these technologies to make the patient experience more pleasant while engaging existing and new patients. DSO industry partner Aggie Pennington of DentalEZ examines dental equipment technologies and the need to modernize and standardize affiliate offices with some of these newest technologies. Caries detection devices, CAD/CAM milling units, LED lighting, and smart technology devices incorporated into affiliate practices can drive efficiency through modernization. Dental equipment is evolving, and we will get to a point where most, if not all, dental equipment will be connected to the internet. DSOs and industry partners can monitor data in several different ways to determine equipment usage, use the internet connectivity to diagnose performance issues, and evaluate effectiveness of the equipment. Troubleshooting can be done remotely, potentially saving the practices an onsite visit from a service technician. Start your dental group’s year off right by reading our Dental Forecast. While technology and modernization are the main focus of the article, there are other key takeaways you are not going to want to miss. Here’s to a modern approach to your dental group in 2018,

Bill Neumann Publisher 4

Efficiency In Group Practice : ISSUE 1 • 2018

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A Look Ahead to ADSO’s 2018 Annual Summit Editor’s note: When dentists receive good administrative support services, they can focus on patients, expand access to quality dental care and improve the oral health of their communities. In this issue, the Association of Dental Support Organizations (ADSO) presents its 2018 Annual Summit.

The Association of Dental Support Organizations (ADSO) plans to host more than 800 attendees at the upcoming 2018 Annual Summit in Austin, Texas. The conference will begin the morning of April 17 and conclude Friday evening, April 20.


Efficiency In Group Practice : ISSUE 1 • 2018

The Annual Summit is consistently the gold standard event for the DSO industry. This year’s summit will feature presentations on the latest developments from leading industry partners; insight on the direction of the industry; discussion on growth and development for all sizes and stages of DSOs; panels on marketing and operations, and more. The summit has previously hosted outstanding keynote speakers, including political analyst Charlie Cook and George Blankenship, a former executive at Tesla Motors, Apple Computer and GAP Inc. Throughout the week, attendees will have the unique opportunity to network directly with other members of the DSO community, from CEOs of the largest DSOs in the country to those just starting out. The premier DSO event will include a networking reception to cap off the week of dialogue, new ideas and relationship building. Registration can be done at


Championing Hygiene in 2018

By Valerie Dangler-Ferro, Enhanced Hygiene

It’s here! 2018 brings a new year with new goals and opportunities. Most group practice owners have evaluated their business and set initiatives for the new year. Commonly, groups have determined their strategy to include solutions on how to be more cost effective and improve EBITA (earnings before interest, taxes and amortization), while maintaining high integrity in patient care and service that supports the brand. Goal setting While establishing goals for 2018, many are looking at ways to grow their group’s locations, either by affiliation or from the beginning on their own. Some are looking at ways their clinical teams can strengthen their connection with patients 8

Efficiency In Group Practice : ISSUE 1 • 2018

and master case acceptance. Some are looking at ways to equip their teams with skills necessary for professional growth that will further support and strengthen the organization.

An essential component

When evaluating the needs of your group and how to accomplish growth while meeting the expectations of today’s dental patient, training is an essential component to your group’s overall strategy. There is no doubt that having clear, concise systems that are followed with consistency will improve your groups’ employee engagement in every business interaction,

Finally, there’s an intraoral camera that is easy to use, captures crystal clear images and integrates with your imaging software. For less than $300. Seriously.

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whether with a patient on the phone, in the operatory, or effective communication and consistency will be key to during the financial close. Having foundational systems in your group’s growth. We also know that teams that train place is necessary for emerging groups to duplicate from together, stick together, resulting in high-performing office to office, employee to employee, and amongst every teams with less turnover and reduced stress in the workpatient resulting in overall satisfaction and profitability. place. Happier employees will generate happier patients We know that 80 percent of the reason why patients are driven to your Having a trained team calibrated and on the practice is because they want their same page to deliver comprehensive care with “teeth cleaned.” Hygienists are caring, compassionate healthcare providers effective communication and consistency will that put heart into the care for their be key to your group’s growth. We also know patients. They spend the most time that teams that train together, stick together, with the patients, building relationresulting in high performing teams with less ships and trust. They are influential in the patient’s commitment to care, turn-over and reduced stress in the workplace. retention, and referrals in the practice. If you have not considered training your hygiene departwho retain and refer, leading to organic practice growth, ment, it is time to champion your hygiene team. healthier patients and keep your practices on track while Having your hygiene department equipped with allowing your teams to be their best! strategies to achieve greater patient care and satisfac2018 is here, are you ready to champion your team? tion not only produces a strong outcome for hygiene Enhanced Hygiene will be hosting their wellrevenue, but it fills the general dentists and specialty known “Hygiene Champion Workshop” in April 2018. schedules as well. Having a trained team calibrated and If you are interested in attending, please email us at on the same page to deliver comprehensive care with ISSUE 1 • 2018 :


Dental Forecast


Efficiency In Group Practice : ISSUE 1 â&#x20AC;¢ 2018

2 What 18 to Expect

By Laura Thill

If there’s one thing that hasn’t changed in dentistry, it’s that the industry is constantly changing. DSOs and dental practices continue to expand, both in number and size of locations. More patients than ever before are seeking dental treatment. At the same time, it’s become increasingly competitive for dental practices to attract and maintain patients. As a result, dentists and their staff are turning to new technology to offer cutting-edge services and foster the clinician-patient bond. Efficiency in Group Practice spoke to industry experts about the changes we can expect to see in 2018, and how DSOs can stay ahead of the game and continue to be leaders in patient care.

ISSUE 1 • 2018 : 11

Dental Forecast

AJ Acierno, DDS, CEO, DecisionOne Dental Partners Shrinking reimbursement and mounting school debt will continue to force dentists to adopt new, more efficient technologies and nurture the doctor-patient bond.

AJ Acierno


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The dental industry has been in transition, and 2018 brings yet more change. “There are two main areas that I believe will continue to evolve in the dental industry,” says AJ Acierno, DDS, CEO, DecisionOne Dental Partners. “First, we will see changes to the hiring process.” The market is competitive, making it increasingly difficult to hire top team members and dentists, he notes. “Staff and doctor turnover is bad for both the dental practice and the patients,” he points out. In order to hire and keep top talent, dental offices will need to stay ahead of the game and make changes to set themselves apart from traditional offices.

this should be celebrated, not feared. All dentists make mistakes, but having the support from a group practice makes it easier to correct those mistakes and improves both our profession and the quality of care our patients receive. EGP: What steps should DSOs take to stay ahead of the game in 2018? Acierno: First, they should focus on technology. We have to find better ways to improve the experience for our patients. When we compare dental to other industries – such as food and entertainment – we are far behind. We have to think like our patients and use technology to improve their experience. The industry

We have to think like our patients and use technology to improve their experience. The industry is on the cusp of developing technology that will make it much simpler for patients to visit their dentist.

Efficiency in Group Practice: What will be some key opportunities for DSOs in 2018? AJ Acierno: As more and more dentists and team members experience the DSO model, 2018 is the time that we can control the message of what a DSO is, rather than letting outside media define what we are. For a long time, terms such as DSO and group practice held negative connotations. National and state dental boards, as well as dental schools across the country, would often speak out about how group practice was bad for the field of dentistry. As we continue to see how private practices around the country are functioning, the concern should shift away from what DSOs are teaching and monitoring, to the shortcomings of many private practices. Dentists working alone in private practice have no one monitoring them or giving them feedback on their standard of care. DSOs, on the other hand, provide a network of dentists who, together, create an environment of collaboration, competition and accountability. The result is that many DSOs provide exceptional care;

is on the cusp of developing technology that will make it much simpler for patients to visit their dentist. Secondly, I think it is time for all dentists to evaluate their relationship with insurance companies. How long will we watch reimbursement negatively impact the quality of dentistry? Of course, insurance provides a great benefit to patients. But we need to think outside the box and come up with ways to help ensure our patients receive quality healthcare, even when reimbursement is low. There are a lot of great ideas circulating. We need organized dentistry and politicians who are willing to fight for quality care. Dentists receive superb education, so it doesn’t make sense to be forced into a system where insurance reimbursements dictate how we practice dentistry. ISSUE 1 • 2018 : 13

Dental Forecast • Social media. Patients want to know about their clinicians on a more personal level. Social media makes it easy for dentists to share information about their office, office outings, their team members’ personal milestones and more.

Patients are more likely to trust dentists who take the time to get to know them. If we could just connect with those patients who are reluctant to follow through on patient visits and treatment plans, we would be busier and more profitable. EGP: How can clinicians and dental team members better connect with their patients in 2018? Acierno: It’s more important than ever before for dentists to form strong relationships with their patients. Patients are more likely to trust dentists who take the time to get to know them. If we could just connect with those patients who are reluctant to follow through on patient visits and treatment plans, we would be busier and more profitable. That said, I think there are three things that set one office apart from the next: •C  ommunity outreach and philanthropy. People notice when clinicians are actively involved in the community, so the more community service dentists provide, the better. •E  fficiency. People are busy, so patients appreciate faster office visits. When dentists rely on technology to help their office run efficiently, patients are more likely to have a better experience. 14

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In addition, dentists should always ask their patients what they do and don’t want. Patients want to have some input in their treatment plan. It requires a lot of communication skills and time to find those secrets that will attract more patients to your office.

EGP: What industry trends will we see in the next several years? How can DSOs plan ahead? Acierno: I believe staying ahead of technology and using that to improve the patient experience will continue to be essential. Digital analytics will define the dental landscape five years from now. In addition: • T he reliance on insurance and government funding has put many groups in a vulnerable position. We have to decrease that vulnerability as groups grow. • We must create groups that can increase both the quality of patient care and the quality of our team members’ lives. If we continue to just make decisions based on the bottom line alone, we will lose the fabric that makes our profession great: our relationships with our patients and team members.

“We will continue to deal with the fact that insurance companies will not increase reimbursement any time soon, dentists will graduate from school with huge debt, and a large portion of their salary will continue to go toward student debt repayment,” he says. “If their salaries were increasing at the same rate of dental tuition, I would feel a lot better.”

Greg Nodland, president, GEDC DSOs must continue to find ways to connect with patients, including an informed team member, new technology, social media and Wi-Fi. As more and more dentists graduate from dental school, the dental workforce continues to get younger, notes Greg Nodland, president, Great Expressions Dental Centers. Today, there are more female dentists entering the market, he points out. DSOs continue to grow in market share, as more dentists retire and dentists just out of school are faced with large debts and barriers to buying their own practice. Additionally, more dentists are looking to DSOs to assist them with their business responsibilities and free them up to focus on the clinical services they provide.

Greg Nodland

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Dental Forecast “We can expect to see dental care use rise – particularly for lower-income children and higher-income seniors,” Nodland says. “Dental care use will likely be flat or slightly higher among adults overall, and increase slightly among lower-income adults due to Affordable Care Act. We will see an increase in Medicaid patients, and more Medicaid emergency visits.” As a result, some dental groups will need to adjust their approach to capture this group of patients. As the dental industry is impacted by new economic forces, and more small players enter the market, we will continue to see consolidation of solo and small groups into large group practices and DSOs, he adds. Efficiency in Group Practice: What will be some key opportunities for DSOs in 2018? Greg Nodland: DSOs should continue to market to young patients who are in their 20s and 30s, as more and

Nodland: DSOs should look at their operations to see if they are equipped to support newer shifts and trends in the industry. Then they must adjust their operations as needed. For example, they may need to do more targeted/segmented marketing, or revamp a training module. In addition, DSOs should invest in patient-facing technology to make it easier for patients to interact with their dental provider. Patients expect ease through technology and it will be important for our industry to meet this expectation. EGP: How can clinicians and dental team members better connect with their patients in 2018? Nodland: At Great Expressions Dental Centers, we put a big focus on the patient- relationship. We have invested in training through GEDCU, as well as invested in items patients have told us they want. We’ve discovered the following: • It is critical to minimize team member turnover. To be successful, dental practices need a well-oiled team that works together to ensure the patient experience is exceptional. Team member turnover can disrupt the office flow and inhibit the team’s ability to connect with their patients.

DSOs should continue to market to young patients who are in their 20s and 30s, as more and more are getting dental coverage. The recent increase in dental coverage rates, and reductions in cost barriers to dental care, may help facilitate dental care use.


• It’s important to offer patients an easy way to pay their bills, such as online bill pay, auto pay and/or a patient portal specific to their care, which they may access on the dental website or via a mobile app.

more are getting dental coverage. The recent increase in dental coverage rates, and reductions in cost barriers to dental care, may help facilitate dental care use. In addition, DSOs must meet the needs of the newly graduating dentists who seek flexibility and financial security. More and more of these dentists see DSOs as a path to a viable career. The DSOs that can match their business plans to the needs of the changing dentist population will succeed.

• Team huddles make a difference. This is an opportunity for dentists and their team members to review the needs of each patient visiting the office that day. A prepared team can address their patients by name, put them at ease with casual conversation and better attend to their clinical needs.

EGP: What steps should DSOs take to stay ahead of the game in 2018?

• Monthly or annual membership plans are an option for patients who don’t have dental insurance. Each

Efficiency In Group Practice : ISSUE 1 • 2018


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member pays to receive discounts and benefits from the dental practice/dental group. Creating membership plans demonstrates to patients that the practice cares about them. Patients, in turn, will be more likely to return for future visits, as well as refer their family and friends. • All dental offices should offer free Wi-Fi. Patients expect – and value – it. In fact, when they can use their devices in the waiting area to research their dental needs, they often ask more informed questions during their visit. • Social media helps dentists and team members connect with their patients. At GEDC, we’ve discovered social media is a great way to generate interest in – and enthusiasm about – our offices. Posting photos and news facilitates word-of-mouth marketing. • Patients enjoy providing online reviews. Making it easy for them to do so helps strengthen the dentist/team

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member/patient bond. At GEDC, we work with a third party to automate invites, which are sent to every patient at the time of checkout. With a couple of clicks on their mobile phone, patients can easily leave a review if they are so inclined. EGP: What industry trends will we see in the next several years? How can DSOs plan ahead? Nodland: We can expect to see more industry consolidation as the DSO model continues to meet the needs of both a changing population of dentists and patients, whose dental coverage constantly changes. We will also see a growing market for both young and old patients, more patients with dental insurance, and greater digital interaction with patients, such as online reviews, voice search and more. DSOs and large group practices can look at trends in similar industries to see what might be impacting them soon. Patient research will continue to be key in helping dentists determine what patients want, both today and over the next couple of years. ISSUE 1 • 2018 : 17

Dental Forecast

Aggie Pennington, national strategic accounts inside sales manager, DentalEZ As dental practices continue to expand, they must offer cutting edge technology to provide more efficient service and strengthen the clinician-patient bond. The dental profession is in transition, largely due to a rise in new technology and the growth of group practices, according to Aggie Pennington, national strategic accounts inside sales manager, DentalEZ. “The most significant change is due to the growth of group practices,” she says. “In the past, a group practice was defined as having three or more dentists. Today, dental groups vary in ownership, number of locations and planning strategy. As such, the main concern is to ensure that patient care is decided by a practicing dentist and is based on the needs of the patient. As more research is conducted, these groups will be better defined and stricter standards will be set. 18

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Aggie Pennington

Large group practices need an aggressive marketing plan and an attractive program, enabling them to integrate smaller groups they wish to acquire.

Efficiency in Group Practice: What will be some key opportunities for DSOs in 2018? Aggie Pennington: 2018 will continue to be a year of growth for group dental practices – particularly for dentists working to transform their practice into a DSO and for larger groups acquiring smaller regional or more established groups and building de novo offices.

they work to strengthen their relationship with patients. Happy patients are more likely to stay with a practice and recommend it to their family and friends.

EGP: What steps should DSOs take to stay ahead of the game in 2018? Pennington: Large group practices need an aggressive marketing plan and an attractive program, enabling them to integrate smaller groups they wish to acquire. In order to expand their offices and increase their patient base, their marketing strategy must focus both on smaller, emerging groups and the patients themselves.

EGP: What industry trends will we see in the next several years? How can DSOs plan ahead? Pennington: The dental industry continues to introduce new technology designed to make the patient experience better, easier and faster, including: • Preventative products that assist with caries detection. • Equipment that permits a crown to be completed in a single visit to the dentist office. • Digital denture technology. • LED lighting. • Touch screen electric handpieces equipped with smart technology.

EGP: How can clinicians and dental team members better connect with their patients in 2018? Pennington: Both clinicians and their dental staff need to make their patients feel like a priority. This is critical given the transition occurring in the industry and the aggressive competition clinicians and staff face as

Large DSOs should stay informed about new technology and plan ways to integrate these products into their offices. A dental practice is likely to keep current patients and attract new ones if it brands itself as a progressive user of technology and shows patients the value it provides by offering better, easier and faster care. ISSUE 1 • 2018 : 19


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Products to Watch The best products for your practice in 2018

Efficiency in Group Practice asked a handful of manufacturers about new products and services in 2018 that will help their group practices flourish. Here are their responses.

ISSUE 1 â&#x20AC;˘ 2018 : 21

Products to Watch

Ivoclar Vivadent Direct composite restorations are the second most common procedure in the dental practice, after hygiene. Ivoclar Vivadent’s Tetric EvoFlow® Bulk Fill is a high-performance, flowable composite developed to improve efficiency and esthetics when placing posterior composite restorations. Available in three basic shades (IVA, IVB and IVW) and in syringe- or Cavifil-delivery, this new flowable composite streamlines existing composite placement procedures. Tetric EvoFlow Bulk Fill offers self-adapting and self-leveling properties, which eliminate voids and provide dentin-like opacity for a more natural esthetic result. Curing time is reduced, with the ability to cure up to 4 mm increments in just 10 seconds! Finally, the material’s high-level radiopacity allows for easy detection on radiographs. (1The Key Group, 2015 Dental Omnibus – 2nd quarter report.)

Key features include: •E  fficient Placement. Tetric EvoFlow Bulk Fill offers faster and more efficient placement of posterior composite restorations due to its unique flow properties and the opportunity to place increments up to 4 mm in depth. During placement, the material self-adapts to cavity walls and provides a level surface for the final occlusal layer, helping to eliminate voids. •F  ast Cure. Tetric EvoFlow Bulk Fill features Ivocerin™, a patented photo-initiator system that is more reactive to dental curing lights, resulting in faster, more complete polymerization. Unlike other flowable composite materials, Tetric EvoFlow Bulk Fill can be polymerized with just one 10-second cure from the occlusal surface when using a curing light with output >1,000 mW/cm2 (or 5 seconds using a curing light with output >2,000 mW/cm2). 22

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• Low Shrinkage Stress. A unique filler technology reduces shrinkage-stress – an important physical property specifically when polymerizing large Class I and Class II composite restorations. The filler technology in Tetric EvoFlow Bulk Fill keeps the material from pulling away from cavity walls during polymerization, improving marginal integrity. • Natural Esthetics. While many “bulk fill” composites result in low value or a gray appearance, Tetric EvoFlow Bulk Fill provides a dentin-like opacity after polymerization. This is the result of Assencio™ technology. Unlike any other flowable bulk fill composite, the material is translucent during placement, allowing for a deep depth of cure, and it becomes opaque during the curing process. The dentin-like opacity provides a more natural-esthetic appearance of the restoration after the final occlusal layer has been placed. The unique technologies found in Tetric EvoFlow Bulk Fill reduce the number of steps in the direct restorative procedure and lead to more durable and natural-esthetic restorations. This flowable composite can be easily integrated into any existing resin-based composite system. Editor’s note: Sponsored by Ivoclar Vivadent.

Crosstex /Accutron™ ®

Capnography Adapters for Use with N2O/O2 Sedation Capnography – a patient safety feature designed to monitor breathing – is recognized as a valuable warning device for use during sedation treatment. The capnograph enables clinicians to instantly recognize ventilation and circulatory events that – if uncorrected – could potentially lead to hypoxia. Capnograph monitoring is an American Association of Oral and Maxillofacial Surgeons requirement for renewed licensure (AAOMS ParCare, 2012) and is recommended in the American Academy of Pediatric Dentistry and the American Academy of Pediatrics guidelines for sedation, when moderate or other deeper levels of sedation are employed.

Introducing Axess™ Capnography Adapters Crosstex®/Accutron™, manufacturer of the Axess nitrous oxide/oxygen sedation product line, has recently expanded its offerings to include Axess™ Capnography Adapters. The new capnography adapters complete the Axess product line, which includes low-profile, single-use translucent nasal masks and scavenging circuits.

The adapters provide a CO2 capnograph monitor sample line connection for the purpose of monitoring patient end-tidal carbon dioxide (EtCO2). Axess capnography sampling draws from within the nasal mask, measuring patient exhalation (EtCO2) at the source. The adapter is inserted between the Axess Nasal Mask and Scavenging Circuit, with the flexibility to connect to either the right or left side of the patient mask, depending on which is more convenient for the clinician. The single-use Axess Capnography Adapters are individually packaged in ZipLoc® bags to minimize cross-contamination, and the non-latex material offers protection to patients and staff who have latex allergies.

Highlighting the Axess™ Advantage For dental practices using N2O/O2, the Axess capnograph adapter offers a convenient, easy solution. Traditionally, dentists have placed the sample line within the nasal mask and taped it under the patient’s nose, making it awkward to secure and uncomfortable for the patient. With Axess™ Advantage, it is easier to introduce the sample line into the system, more comfortable for the patient, and it will not potentially disturb the nasal mask seal and allow gas to seep into the clinician’s work zone and into the atmosphere. For more information about the Axess product line, or to request Axess Nasal Mask samples for your doctors, visit us at Editor’s note: Sponsored by Crosstex®/Accutron™. ISSUE 1 • 2018 : 23

Products to Watch

Hu-Friedy Group practices face unique challenges and need product solutions that address issues including cost savings, efficiency, standardization, compliance, safety, value, employee retention and more. Instrument Management System (IMS) is a simple and effective solution that addresses those needs. The system supports implementation of proper infection prevention protocols that comply with the recommendations of the Centers for Disease Control and Prevention (CDC). By standardizing procedural setups, IMS allows clinicians to move instruments from cleaning through chairside in a consistent process delivering increasing safety, enhanced efficiencies, time savings and other cost-saving benefits.

IMS makes it easy for consistent training in all practice locations. With the time savings gained, offices have additional time to see more patients and spend on more value-added activities in the dental practice. 24

Many practices still carry instruments on a tray, hand scrub and bundle them together for cleaning and sterilization. This leads to sharps injuries and impairs the dental office workflow. IMS minimizes the time consuming and dangerous handling of instruments by pre-sorting and organizing the instruments by procedure type. Once configured, the instrument set up remains complete through transportation, cleaning, packaging, sterilization and storage, reducing the chance of sharps injuries. Instrument cassettes are placed directly into ultrasonic cleaners, dental instrument washers and sterilizers,

Efficiency In Group Practice : ISSUE 1 â&#x20AC;˘ 2018

eliminating the need to hand scrub, protecting staff. Because instruments are always kept together in the cassettes, offices incur less risk of damage, loss and misplacement of instruments, saving money and making inventory and procedure preparation much easier. Offices can save an average of five to ten minutes per procedure, thanks to the organization and efficiency of IMS. Think of IMS as an extra assistant: the system standardizes procedural set-ups and creates a process that is less people-dependent. All of the practices in the group will be following the same protocols, using the same process. IMS makes it easy for consistent training in all practice locations. With the time savings gained, team members have additional time to see more patients and spend on more value-added activities in the dental practice. Patients will also be able to see the professional chairside presentation of sterile packages that have been prepared for them, likely enhancing practice referrals. IMS offers an enhanced level of efficiency and safety that can be gained in every dental sterilization process. To gain a better understanding of how IMS works, see a short side-by-side video comparison or to understand the potential ROI of implementing into your practice, visit Editorâ&#x20AC;&#x2122;s note: Sponsored by Hu-Friedy.

MOVING FORWARD. TOGETHER. Because Every Step Matters in Infection Prevention



VISIT US ONLINE AT HU-FRIEDY.COM/Reprocess to view our full line of Infection Control products ©2018 Hu-Friedy Mfg. Co., LLC. All rights reserved. [735]




Products to Watch

VOCO Ionolux is a light cured resin modified glass ionomer restorative that offers unique physical properties and benefits, including composite-like esthetics, an ability to be condensed, shaped and sculpted immediately after application, non-stick handling and improved physical properties for better longevity. Ionolux’s enhanced composite-like esthetics allows the practitioner to deliver a fluoride-releasing restorative without sacrificing the esthetics. This enables practitioners to offer higher quality care for at-risk demographics, such as the pediatric and geriatric populations. As a light-cured resin modified glass ionomer with immediate packability and non-stick handling, Ionolux simplifies the overall procedure for both the practitioner and the patient, saving valuable time, increasing ROI and minimizing discomfort while providing an economical yet high quality, fluoride-releasing solution.

Ionolux has great physical properties that include a high compressive strength of 200 MPa and low water solubility of 0.2 percent. The material is highly radiopaque and has excellent translucency for better esthetic results. The range of indications for Ionolux include: Class III and V restorations, primarily cervical fillings and root caries, restorations of deciduous teeth, small Class I restorations, temporary restorations, core build-ups and linings. Ionolux is great as a dentin replacement when used in the open and closed sandwich technique. Ionolux caters to patients who need treatments that limit the necessary steps to the absolute minimum without sacrificing esthetics. Additionally, a 26

Efficiency In Group Practice : ISSUE 1 • 2018

higher quality of care is achieved, especially in the pediatric and geriatric demographics. With these two demographics, the less procedural steps keep the relative stress involved in the restoration to a manageable level for both the patient and practitioner. Ionolux saves time, since no conditioning or adhesive is required and setting time is minimized with the light-cure feature. Patients are not anxious and practitioners are assured a quality long-term restoration. Ionolux comes in VOCO’s new Direct Activation Capsule for simplified activation, without the need of a bulky activation device. Merely press the capsule down on a hard surface, such as a table, to activate the mixture of the powder and liquid. This new capsule eliminates mixing ratio errors and the incorporation of air bubbles. The low profile of the capsule makes it easy to access difficult-to-reach areas within the mouth, and the capsule fits most standard application guns. Ionolux is available in five highly esthetic shades (A1, A2, A3, A3.5 and B1). By adding Ionolux to one’s daily restorative regimens, clinicians can rest assured that they are providing their patients with a fast but highly esthetic, high fluoride-releasing restorative that elevates the quality of care, while saving time and money. Editor’s note: Sponsored by VOCO.

VOCO Futurabond U is dual-cure universal adhesive in a patented SingleDose delivery system that can be used in self-etch, total-etch and selective-etch techniques and works with all light-, self- or dual-cured resin based materials. This makes Futurabond U a true universal adhesive for all bonding situations, eliminating the need for multiple adhesive systems and providing a singular solution for offices that employ multiple practitioners possessing differing technique preferences in adhesive dentistry. Futurabond U is fast and easyto-use, requiring only 35 seconds of working time (apply, dry and cure) and a single-coat application. The patented delivery system eliminates the evaporation of the solvent, which exists with bottle systems, and ensures consistent, reliable chemistry at each application.

The material is reinforced with nano particles for improved wettability, sustained bond strength and increased penetration within the dental tubules, eliminating virtually any or all post-operative sensitivity. Futurabond U achieves over 30 MPa of adhesion to dentin and enamel with light-cured composites and strong bond strengths with dual-cure and self-cure composites. The material has a low pH value and a low film thickness. Futurabond U is indicated for all direct and indirect restorations, core build-ups, such as a luting composite, intraoral repair of fillings, ceramic veneers and all ceramic restorations, and it does not require an additional primer. Futurabond U is also indicated for the treatment of hypersensitive tooth necks, as a protective

varnish for glass ionomer cement restorations, sealing of cavities prior to amalgam restorations or prior to temporary cementation and cementation of root posts. Futurabond U provides greater efficiency in your everyday workflow, due to its fast and simple application as well as its technique flexibility. This also creates enhanced patient comfort and reduced stress for the clinician. Without the need for multiple bonding agents with varying steps or additional primers when bonding to metal, zirconia, aluminum oxide and silicate ceramic, its true universal properties save time and money with the use of this adhesive system. Its highly hygienic SingleDose delivery system increases consistency and eliminates variables, which can lead to undesirable outcomes. Futurabond U requires no refrigeration or shaking of the material. It is the ideal adhesive in root canal cementation and there is no pooling effect with this material. Special endo brushes can be purchased to help facilitate the application of the material into the canal, and the adhesive does not start to cure until it comes into contact with the dual-cure core build-up material. Futurabond U is available in 50 packs and 200 packs and as a Trial Kit. Editorâ&#x20AC;&#x2122;s note: Sponsored by VOCO. ISSUE 1 â&#x20AC;˘ 2018 : 27

Products to Watch

Isolite Productivity and predictability are the cornerstones of success for group practices. While there is a real need and desire to increase production and efficiency, shortcuts that could potentially reduce the efficacy or quality of care provided to patients are unacceptable. If those pressure weren’t enough, as the competitive environment continues to grow, differentiating your practice from those around you is equally important. Finding ways to distinguish your practice as the high-tech, efficient, comfort-conscious office that gets the job done right the first time can make a meaningful difference to the number of patients who remain loyal to your group. Many of these issues can be addressed with the Isolite dental isolation system. The Isolite was designed specifically to help practices improve productivity and efficiency by making the most common dental procedures easier. The Isolite system converges illumination, suction and retraction into a single device that not only speeds up procedures but also provides comfort and additional safety to the patient. Because the Isolite provides constant

suction and retraction, dental assistants are free to focus more on you and the patient. RDAs can stay a step ahead of a procedure, making sure that dentists aren’t waiting for the item they need next. Studies have shown that the combination of the Isolite and Isolite mouthpiece reduce humidity in the mouth on par with that of a traditional rubber dam. Yet the Isolite mouthpiece can be placed in the patient’s mouth, isolating an entire quadrant in seconds compared with the time it takes to set a rubber dam. The Isolite mouthpiece also has an integrated bite block, making the procedure more comfortable for the patient. The Isolite mouthpiece provides two additional benefits to both patient and clinician. The mouthpiece comes in six different sizes and keeps the tongue retracted and away from the working area for the entire procedure. Additionally, the mouthpiece provides a measure of safety and insurance by protecting the patient’s airway from the accidental ingestion or aspiration of small tools or stray fragments from the procedure. Using an Isolite system in your group practice can dramatically improve procedural efficiencies and productivity without compromising patient safety or quality of care. Editor’s note: Sponsored by Isolite.


Efficiency In Group Practice : ISSUE 1 • 2018

KaVo ELECTROmatic System TM

• Primary function: • Air-to-electric electric upgrade system with dual motor and endo options. • Life of equipment: • K aVo’s trusted quality – together with a 3-year warranty and modular system for easy replacement of water filters and tubing – ensure the ELECTROmatic delivers versatility, excellence and comfort. • KaVo’s MASTERmatic and EXPERTmatic electric handpieces come with a two-year warranty, which can be extended to 2.5 years when maintained with a QUATTROcare plus maintenance system. • Repair or replace? • The ELECTROmatic system’s modular design allows for easy technician-free part replacement for water filters, LED bulbs and tubing. • How it works: • By combining the new KaVo ELECTROmatic with KaVo’s industry-leading electric handpieces and a short, powerful, lightweight motor, KaVo provides an ideal solution for synchronized efficiency. • What you need to know: The KaVo ELECTROmatic is available in three models, which means there is an electric solution for every dental office. The ELECTROmatic is the first dual-motor electric retrofit system in North America. • With 20 pre-programmed endodontic file systems and reciprocal movement, the ELECTROmatic Premium offers a true all-in-one electric platform. • Improvements to the technology: • ELECTROmatic control box: • Dual motor option. • Dentists can choose remote mount display for the best ergonomic viewing position. • Over 20 preprogramed endo file systems. • SMARTdrive sensorless control allows a high torque at low-speed ranges.


• MASTERmatic handpiece: • KaVo has paired the ELECTROmatic with the MASTERmatic LUX M25 L and the MASTERmatic LUX M05 L Mini High-speeds, which combine small head size with powerful and quite performance. The MASTERmatic high-speed attachments feature a triple-gear system for smooth, reliable operation and patented angles for superior access. • COMFORTdrive handpiece: •K  aVo’s most innovative handpiece – the COMFORTdrive 200XDR – offers a blend of optimal performance and superior ergonomics, with nearly silent operation. Thanks to integrated micromotor technology, COMFORTdrive delivers the precise cutting performance of an electric handpiece, with a light-weight, ergonomic design similar to that of an air-driven handpiece. • KL703 LED short motor: • The KL703 LED brushless electric motor is 30 percent lighter and 25 percent shorter than other market leading electrics. Paired with KaVo’s ELECTROmatic systems, it connects with any attachment with ISO 3694 (E-style) connection. • Price range: • $1,899-$4,199 MSRP. KaVo ELECTROmatic Highlights • KaVo’s ELECTROmatic provides the most recent improvements in electric handpieces. • With three models from which to choose, the KaVo ELECTROmatic offers an electric solution for every office. • KaVo’s ELECTROmatic SAFEdrive feature, MASTERmatic handpiece quality and the QUATROcare maintenance system have addressed any overheating concerns. • The KaVo KL703 short motor and COMFORTdrive, together with the MASTERmatic M25L and M05L, address any heavy or bulky handpiece concerns. • KaVo quality handpieces provide the dental practice with versatility, excellence and comfort. • With three models from which to choose, the KaVo ELECTROmatic offers an electric solution for every office, no matter what its needs and budget is. Editor’s note: Sponsored by KaVo Kerr. ISSUE 1 • 2018 : 29

Products to Watch

NSK Outstanding power for faster cutting and a smaller risk of operation downtime are just some of the reasons why electric micromotor systems continue to grow in popularity in dental practices. There’s another reason too: Given the small equipment and various instruments and materials that need to be situated on or around the delivery unit, space is at a premium for today’s busy dental practices, and the ability to free up space can be a huge advantage to dentists and their team. Micromotor systems can help.

NSK has introduced the NLZ electric micromotor system, designed to deliver all of the specs of a premium electric motor with the highest standards, but in the smallest package possible. The NLZ features flexibility for different installation styles and allows the user of any air-driven handpiece to convert to electric, expanding the possibilities of dental treatment. NLZ’s smaller micromotor provides easier handling and great balance when held in one’s hand, causing less fatigue on dentists’ hands and shoulders. In addition, the smaller head size of the handpiece provides excellent access and visibility inside the patient’s mouth for hard-to-reach areas. Not only has every part of the NLZ been reduced in size, minimizing the space needed for the installation, the unit features a separate control point. 30

Efficiency In Group Practice : ISSUE 1 • 2018

The main unit fits under the counter, with only the control point visible. As a result, the area around the dentist chair remains neat and tidy. Dental units come in many shapes, styles and sizes, and NLZ is uniquely designed for mounting and installation on all of them. Its split form, with two different types of brackets, allows technicians to be creative and mount it on any type of delivery unit. NLZ provides cutting-edge features applicable to a wide range of endodontic treatments, with enhanced comfort and safety. NLZ Endo, a newly developed reciprocating electric attachment, builds on NSK’s existing handpiece technology by allowing for greater movement during reciprocating operations. In addition, the NLZ-E model can be used for all kinds of restorative high-speed and lowspeed treatments, as well as endo operations, including rotary, reciprocating and WaveOne. In Endo mode, torque range is 0.3 to 6 Ncm, which supports all kinds of major files available in the market. NLZ introduces the highest safety standards in electric micromotor systems, with Contra-Check and Contra-SAFE functions. The NLZ system carries NSK’s unique Worry Free Warranty for the entire three-year warranty period. Editor’s note: Sponsored by NSK.


Zirc’s mr. thirsty one-step is an all-in-one hands-free isolation device that retracts, isolates and evacuates. The device enhances patient comfort by protecting the airway, and the built in bite block allows the patient’s jaw to be at rest. The device is low-cost with no start up investment and hooks directly to the treatment room’s existing HVE valve, eliminating any upfront investment. It comes fully assembled and is 100 percent disposable. Available in two sizes, which may be trimmed if necessary, mr. thirsty decreases chair time by as much as 29 percent, facilitating a more enjoyable patient experience. In addition, the saved time allows the doctor to see more patients through-

The hygienist will enjoy using mr. thirsty for sealants and ultrasonic scaling.

out the day, which in turn can lead to increased revenue. Mr. thirsty’s colorful, non-threatening appearance helps put the patient’s mind at ease. Mr. thirsty benefits doctors by allowing them to prep the tooth independently, allowing the assistant to perform other duties. The hygienist will enjoy using mr. thirsty for sealants and ultrasonic scaling. Mr. thirsty is the perfect hands-free isolation device to decrease patient chair time and increase productivity for the dental office. Editor’s note: Sponsored by Zirc. ISSUE 1 • 2018 : 31

Products to Watch

Tuttnauer The Tuttnauer EZ11Plus fully automatic sterilizer – the “The Perfect Primary Unit” – paired with the Valueklave 1730 manual sterilizer – “The Perfect Cassette Alternative Unit” – make the “The Perfect Pair.”

Its fast cycle time sterilizes unwrapped instruments in 11 minutes (come-up time, sterilization exposure and exhaust).

The EZ11Plus fully automatic sterilizer, “The Perfect Primary Unit,” is designed to meet the most current sterilization standards ANSI/AAMI ST55. The EZGlide self-locking door is ergonomically friendly and can be opened and closed effortlessly. The EZView display screen is full color and easy to read, even from a distance. As a convenience for the operator, the EZFill water reservoir can be filled with distilled water from the top of the unit, as well as through the front fill funnel located inside the door. The EZ11Plus model features an 11-inch chamber and includes five large trays. For those offices using cassettes, it can accommodate four full-size cassettes and four halfsize cassettes. The EZ11Plus also features a dynamic air removal technology and an active closed-door HEPA filtered air-drying system to maintain sterility and 32

Efficiency In Group Practice : ISSUE 1 • 2018

ensure efficient drying of packs and pouches. It comes standard with a USB port to transfer cycle data, a network port to connect a local network and provide remote monitoring of the system, and an optional printer. Tuttnauer is the only manufacturer to offer a two-year warranty on parts and labor and an additional 10-year warranty on the chamber for all of its fully automatic autoclaves. The Valueklave 1730 manual sterilizer, “The Perfect Cassette Alternative Unit,” is small, fast and economically priced. The bright, easy to use panel is designed with the operator in mind. Its fast cycle time sterilizes unwrapped instruments in 11 minutes (come-up time, sterilization exposure and exhaust). The seven-inch chamber size comes with three small stainless steel trays and there is no need for special cassettes. It effectively dries wrapped instruments and is larger than some single cassette units. The Valueklave 1730 comes with a one-year warranty on parts and labor and an additional 10-year chamber warranty. Tuttnauer continues to offer the largest selection of autoclaves to the marketplace. Their single focus on sterilization and infection control enables them to offer products to help practitioners meet today’s challenging workloads and regulatory requirements. Editor’s note: Sponsored by Tuttnauer.




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Designed to meet the most current sterilization standards ANSI/AAMI ST55

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This ensures the door remains closed throughout the dry cycle to maintain sterility and efficient drying of packs and pouches.


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Products to Watch

Preventive Technologies, Inc. (Preventech)

Is your dental practice compliant with infection control standards in your state? The ēsa®(extended straight attachment) disposable prophy angle brings super-simple compliance to all 50 states. Currently, 39 state dental boards subscribe to the CDC Guidelines, which recommend that all dental handpieces and their attachments be heat-sterilized between patients. If a semicritical item is heat-sensitive, DHCP should replace it with a disposable alternative1. In 11 states2, state dental practice acts mandate the heat sterilization of handpieces. With infection control and sterilization of instruments becoming more transparent to patients, more states may be on the verge of adopting similar mandates. ēsa is compatible with several heat-sterilization-tolerant handpieces, including Midwest® Shorty®, Rhino®, Star®Titan and our ēsamate® lube-free handpieces. Because ēsa® eliminates the nose cone, it is 50 percent lighter than traditional handpieces and it costs less to use than both traditional handpieces and DPA connections. ēsamate® handpieces are available in two models: ēsamate® ST, with an aluminum housing that weighs just two ounces, and our new ēsamate® MW, which features a stainless steel housing and weighs 3.2 ounces. Both handpieces are heat-sterilization-tolerant, offer a 360° swivel and connect quickly and easily to ēsa® disposable prophy angles. They feature air-driven performance, which requires no batteries, and run at 5,000 rpm,

which is perfect for prophys. They are backed by a two-year warranty. With the movement in compliance shifting toward sterilization, why limit yourself to a handpiece that’s not heat-tolerant? Instead, talk to us about ēsa and the lubefree ēsamate prophy system. Or, if you already own a Midwest Shorty, Rhino or Star Titan handpiece, have them put an ēsa on it and be compliant wherever they are located. For samples of the ēsa DPA or more information, visit Both the ēsa®DPA and ēsamate handpieces provide fast and easy changeover between patients. Editor’s note: Sponsored by Preventive Technologies, Inc.

1 “Summary of Infection Prevention Practices in Dental Settings” Centers fro Disease Control and Prevention, March 2016, P14. 2 State Dental Practice Boards in CA, FL, KS, OH, OR, SC, VA and WA require semicritical items be sterilized after each patient.


Efficiency In Group Practice : ISSUE 1 • 2018

Hager Worldwide

Dental offices continually look for ways to increase hygiene productivity, efficiency and profitability. But, it’s not always easy to get the entire department on the same page to achieve these goals. That’s why Hager Worldwide created the Mirror Suction – a new tool for hygienists that is easy to integrate, enjoyable to use and designed to help them work more efficiently. The Mirror Suction provides hygienists with a mirror, aspiration and retraction, all in one instrument. It works by connecting to the HVE valve through special tubing and provides strong suction and consistently excellent aspiration through strategically placed holes in the mirror head. Using a mirror with suction offers hygienists several advantages compared to conventional mirrors. For example, water flow can be better controlled during ultra-sonic scaling. This helps hygienists complete the procedure faster, facilitating decreased chair time and a better patient experience. In addition, the Mirror Suction mouth mirror requires fewer items used per procedure and fewer team members to assist, saving the practice money. Sealants, for example, can be applied without assistance. The result is a more efficient dental practice.

When they don’t need to continually stop to clean the mirror face, hygienists can work much faster and efficiently.

In addition, the airflow in the mirror head greatly reduces fogging – a common complaint by hygienists who rely on conventional mouth mirrors. When they don’t need to continually stop to clean the mirror face, hygienists can work much faster and efficiently. Finally, the Mirror Suction is simple to install or uninstall, making it truly a plug-and-play component. The Mirror Suction comes in convenient kits, which include all necessary components, such as mirrors, tubing and adapters. All Mirror Suction components are autoclavable for easy cleaning and maintenance, and the mirrors are available in both single and double-faced versions. For more information, please visit Editor’s note: Sponsored by Hager Worldwide. ISSUE 1 • 2018 : 35

Nitrous Oxide

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

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

“Sedation levels deeper than what are typically found with nitrous oxide (minimal sedation) now require considerably more training than in the past.”


Efficiency In Group Practice : ISSUE 1 • 2018

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

The science behind the technology Enhancements in technology have made it increasingly safer and more efficient for dentists to administer nitrous oxide. Nitrous oxide/oxygen flowmeters have traditionally relied on needle valves and glass tubes to control the flow of gas, according to Keefer. Today’s systems feature flat screen displays; digital, touch pad controls that offer greater accuracy over longer time frames; and enhancements in infection control. As such, it’s important for clinicians to stay up-to-date and educated about the process. Nitrous oxide continues to be administered by inhalation, absorbed by diffusion through the lungs and eliminated via respiration, she notes. Proper equipment for monitoring, and storage unit integrity, are necessary in order to avoid unintended gas leakage or excessive exposure. In addition, clinicians should be educated on the various components of a nitrous oxide/oxygen sedation system: • Nitrous oxide is stored in closed gas cylinders. Oxygen and nitrous oxide are part of the required equipment. • Regulators ensure safe delivery of gas to the patient by reducing/controlling the pressure from the cylinders.


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Attaches between the Mask and the Scavenging Circuit.

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Axess® is a registered trademark of Crosstex International, Inc., a Cantel Medical Company. Accutron™, RFS™, and Acc-Vac™ are trademarks of Accutron, Inc., a subsidiary of Crosstex International, Inc.

• Manifolds in a central delivery system connect several large cylinders of gas together, ensuring the constant availability of gas to each treatment room through copper lines within the walls of the building. • In a portable system, a yoke stand is the metal framework on which the equipment rests and is easily moved on wheels to different areas of the dental office. • Flowmeters are highly calibrated devices designed to indicate the amount of gas being delivered to the patient. Flowmeters further reduce the pressure level to local atmospheric pressure, and restrict the proportion as well as the flow rate of nitrous oxide with a fail-safe mechanism to keep a minimum oxygen concentration of 30 percent. • The reservoir bag contains the gas mixture being delivered to the patient. • Gas is delivered through conduction tubing, which runs from the delivery unit and attaches to the breathing apparatus. • The capnography device monitors patient breathing by measuring the actual CO2 in the patient’s exhalation. • A specially designed nasal mask/hood fits snugly around – and fully covers – the patient’s nose,

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

Resolution 37 In October 2016, the passing of Resolution 37 at the American Dental Association’s (ADA) annual meeting called for revisions to safety regulations for providing anesthesia and sedation, according to Keefer. The rules and regulations for nitrous oxide sedation largely remain the same in light of Resolution 37, she explains. “Healthcare providers are ISSUE 1 • 2018 : 37

Nitrous Oxide required to complete 14 hours of CE for N2O/O2 alone and 16 hours for N2O/O2 combined with a single-dose sedative up to the MRD. MRD is maximum FDA-recommended dose of a drug for unmonitored home use. “Sedation levels deeper than what are typically found with nitrous oxide (minimal sedation) now require considerably more training than in the past,” she continues. “Performing oral, intravenous or any other method Implementing of moderate sedation now nitrous oxide/oxygen requires a 60-hour course sedation in a dental and at least 20 patients. Previously, only a 24-hour, practice – no matter 10-patient course was how small or large – needed. Dentists who were can quickly become already practicing sedation a source of revenue, dentistry before the guideas well as help the lines [were issued] are now required to be re-trained practice address the and will not be grandfaneeds of patients thered in as in the past. anxious about their Critics of the resolution pain management. cite the financial impact of the new regulation, as the increased training will drive costs up, preventing dentists from pursuing advanced sedation training. “Resolution 37 is only a guideline and the ADA has no enforcement authority,” Keffer explains. However, most state dental boards will adapt the ADA guidelines in drafting their own regulations. “Dentists offering sedation can vastly expand the scope of their practice,” she says. “Yet, probably fewer general dentists will elect to go through the trouble and expense to get their moderate sedation certification. Following the dramatic increase in training required for deeper states of sedation, many will limit their practice to nitrous oxide, with or without a single-dose oral sedative up to the MRD.”

Regular service, enhanced safety and longer life expectancy It is important for dental offices to have their nitrous oxide and sedation equipment serviced and calibrated at a minimum every two years, notes Keefer. Doing so can help avoid the potential for leakage and ensure the equipment is safe to use, as well as ensure it runs efficiently for 15-20 years. “Manufacturers recommend various levels of maintenance and service for their units, including routine, 38

Efficiency In Group Practice : ISSUE 1 • 2018

preventive, scheduled and recalibration,” she says. In addition to recalibration, service protocols should include pressure testing and internal component integrity/replacement, as well as any other necessary factory testing procedures. Clinicians should refer to the specific manufacturer’s IFU (Instructions For Use) and follow the recommendations to ensure safe use and delivery of NO2/O2 for patients and staff. The service and inspection of anesthetic gas equipment should be performed by qualified service personnel.”

An investment for the practice Implementing nitrous oxide/oxygen sedation in a dental practice – no matter how small or large – can quickly become a source of revenue, as well as help the practice address the needs of patients anxious about their pain management. (The current ADA/CDT-4 code for billing dental procedures using nitrous oxide/oxygen sedation is 09230.) There are two options for delivering nitrous oxide, notes Keefer: portable units and central systems. “Portable – or self-contained units – can cost between $3,500 for a two-cylinder system to $8,000 for a four-cylinder, enclosed system,” she says, noting that portable systems are recommended for offices that only occasionally use nitrous oxide/oxygen sedation. The cost of centrally installed systems – which are recommended for practices that routinely implement nitrous oxide/oxygen sedation – ranges from $2,500 to $4,000 per operatory, with a total average cost of $28,000 for a midsized office, notes Keefer. “Although the initial set-up costs are high, the central system is more cost-effective in the long run,” she points out. “The smaller E cylinders of a portable system are approximately five times more expensive than the larger G or H cylinders, due to the high cost of packaging the gases. In addition, the centralized system is more convenient, as it minimizes the need to change cylinders frequently. Not only are the cylinders larger than those of a portable system, several cylinders can be connected via a manifold system. When one cylinder is depleted, the system automatically switches to the next available cylinder.” Indeed, when a dental practice considers that the use of nitrous oxide/oxygen sedation systems helps patients relax in the chair – thereby reducing patient chair time and increasing office efficiency – and leads to greater revenue, most clinicians will agree it’s a worthwhile investment. At the end of the day, satisfied patients mean more return visits, more patient referrals and a greater bond with the community.

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

More and more dental offices rely on nitrous oxide/oxygen sedation to reduce patients’ anxiety and help them relax during complex dental procedures. For offices that use nitrous oxide/oxygen sedation even a few times each week, piped – or plumbed – systems could offer the most efficient and economical solution. Although there is an upfront cost for piping a nitrous oxide/oxygen sedation system (i.e., the cost of a medical gas plumber, copper piping, a manifold system, zone valve emergency shut off systems, if required, and a verification/ inspection fee), there are longterm cost savings and benefits of which some clinicians might not be aware, notes Michael Civitello, sales manager, Porter Instrument. “It makes sense for dentists to sit down and evaluate the long-term benefits before making a decision that they may later regret,” he points out. In some cases, portable e-cylinder carts continue to offer a viable solution, he continues. He recommends portable systems when: • The dental office is already built, and there are no options for running piping through a drop ceiling or basement. • The current dental owner will only be at that location for a couple of more years, after which he/she plans to build a new office or stay on as an associate. • The office has no plans to incorporate nitrous oxide/oxygen sedation into its regular routine, and only expects to use it a few times each year. For dental offices looking to offer nitrous oxide/oxygen sedation more routinely, however, there are a number of benefits

to adding piped or plumbed nitrous oxide systems, says Civitello, including: •T  he cost of gas from larger H/G type cylinders compared with E size can easily equate to a $10 savings per patient on the gas itself. “Multiply that times the number of uses per week, and calculate that out over five, 10 or 20 years. It’s a large expense.” •P  ortable e-cylinder systems may seem like a good idea, but compared to a centrally plumbed system, many dentists (as well as assistants) often find reasons to not use them. Portable systems are never ready for use; often are located in another room; require a constant change of cylinders; and take up valuable floor space. In addition, the cylinders generally arrive from the gas suppliers dirty and rusty, and they will be in plain sight of their patients.

• With a central system, every operatory is ready for nitrous use. Having operatories set up for all types of uses helps avoid situations where one case may run long and the office must move a scheduled patient to another operatory, where nitrous may not be available. “Dentists don’t want to be in a position where they are unable to provide nitrous to patients who want or need it.” • If nitrous oxide/oxygen sedation is easier to use, it will be used more often. “The whole reason to have a nitrous system is to provide comfort and relaxation for patients, while at the same time make it easier for the dentist to provide the treatment. Dentists who ISSUE 1 • 2018 : 39

Nitrous Oxide have easy access to nitrous oxide/oxygen sedation are likely to offer it to their patients more often, in situations where it could be beneficial.” • Offices that can offer nitrous oxide – and, in turn, offer their patients a more comfortable, relaxed experience – can make a positive impression and facilitate more return visits. “Patients draw conclusions quickly based on what an office looks like and how it is set up. For instance, is it clean? Does it have modern equipment? That said, does the dentist really want to wheel in a portable cart that has rusty and dirty cylinders and various hoses hanging from it? Or would he/she rather have a built-in professional looking system that is designed for the space?” • Nitrous oxide can be very profitable for a practice. When centrally plumbed, the per-patient cost is very low, particularly when one considers the concurrent fees the office may charge (on average, $75). And, when patients are satisfied with their care, they are more likely to complete – or follow up with – their treatment, return for future care and refer their family and friends to the practice. • Many states are adopting expanded duties certifications for hygienists, permitting those who are qualified to administer nitrous oxide, provided the dentist is on site. “Think of the additional profit the hygienist can produce by offering nitrous oxide to every patient. This isn’t easy to do with a portable E-cylinder cart.” • As more general dentists bring in specialists to their offices, who rely on nitrous oxide/oxygen sedation, an accessible piped-in system is more important than ever. It’s never too early for dentists to start planning their exit strategy, and piped nitrous oxide should be part of it, Civitello adds. “If dentists plan to sell their practice at some point, they should keep in mind that it may not attract specialists, such as pediatric dentists or oral surgeons, who are used to relying on easy access to piped nitrous oxide.”

Rely on the experts Manufacturer equipment specialists can ensure that piped nitrous oxide systems are installed correctly and safely, and 40

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dentists and their sales reps should involve their nitrous equipment manufacturer representative early in the process, notes Civitello. “There are many flowmeter options from which dentists can choose, as well as several installation options,” he points out. Once the needs of the practice and the design of its operatories are clear, the manufacturer rep/equipment specialist can recommend the best possible solutions, as well as advise on what is required from a code perspective. “Many Porter representatives have an ASSE 6005 Medical Gas System Generalist certification, which is essentially the same course that a Certified Medical Gas Plumber takes (without the hands-on/brazing portion).” Equipment specialists can work with a dental office to address a number of important points, including: • Flush mount flowmeters. It’s important to consider the style and type of cabinetry in which the flowmeter will be installed, as not all flowmeters fit in all cabinets. The manufacturers rep can advise which flowmeter will work best in each cabinet style, and how best to position the flowmeter. • Outlet stations. If using outlet stations, it is critical to plan where the outlets will be located. Installing outlets on the wrong side of the room can be a disaster. • Piping. It is essential to pipe all operatories, even if they are not being set up with a flowmeter. Non-functional operatories can be piped, with a termination-point shut-off valve installed. If at some point the practice wishes to expand, the piping is in the wall; it will be easy to access the piping and connect a flowmeter. (If an operatory is not piped, and the office decides to expand, it must bring in a medical gas plumber to cut pipes, rip open walls, etc.) • Detached tank room. When the tank room is detached from the main office, both an automatic changeover manifold and zone valve will be required. An example of this would be a tank room in the basement or in a storage room located outside the main building (with no internal door from the main office to access). Dentists should consider installing an automatic changeover manifold, rather than a manual changeover

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manifold, notes Civitello. “The manual changeover manifold may appear to save them some money,” he says. But, with this option, when the cylinder is empty, someone must go to the tank room to close one cylinder and open another, wasting time. It can be disruptive to a patient’s procedure and inevitably lose the practice money. “With an auto-changeover manifold, when one cylinder runs low, it automatically switches to a full cylinder,” he says. “There is no disruption in the patient procedure, nor does anyone have to go to the tank room.” An experienced manufacturer rep can also ensure that the piped nitrous oxide system is installed by a properly certified plumber, and inspected by an independent third party, Civitello continues. “It’s important that only a certified medical gas plumber works on the piping system,” he says. “These plumbers have an ASSE 6010 certification. They are required to carry an identification card

at all times and are the only ones allowed to handle the piping and installation.” In fact, they can’t have an apprentice assist them unless that individual is ASSE 6010 certified, he points out. “Dentists and/or general contractors absolutely should not hire Joe the plumber who is trained to fix toilets. This is where major mistakes can happen, and it can cost patients their life.” The piping system must be inspected by an independent verifier, notes Civitello. “This cannot be the person who did the installation, and he or she must have an ASSE 6030 medical gas system verifier certification. Dentists and/ or general contractors cannot skip the verification to save $1,000. This is required.” Installation is not complete until both the medical gas plumber and medical gas verifier have conducted all required safety and functional tests, including the crossed lines test, he adds. “In the end, these documents must be turned over to the dentist.”

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

ISSUE 1 • 2018 : 41

Infection Control

Respiratory hygiene and cough etiquette in the dental practice

Infection control principles and practices are integral to the practice of dentistry and the provision of safe patient care, as well as to the dental team members’ health. In general, transmission of bloodborne pathogens (BBP) in the dental setting is rare, but this should not minimize the importance of consistent protocols for reducing the risk of cross-contamination. By Katherine Schrubbe, RDH, BS, M.Ed, PhD Katherine Schrubbe, RDH, BS, M.Ed, PhD, is director of quality assurance at Milwaukee, Wisc.-based Dental Associates.


In 2016, researchers reviewed the literature from 2003-2015 to identify published reports on the transmission of BBP in dentistry. They found the following cases: • Patient-to-patient transmission of hepatitis B in an oral surgery practice, where the suspected cause of transmission was inadequate cleaning of environmental surfaces. •M  ultiple procedural infection control breaches at a free dental clinic, resulting in three patients and two volunteers acquiring hepatitis B. •P  atient-to-patient transmission of hepatitis C in an oral surgery office, where there were many lapses in infection control.1

Efficiency In Group Practice : ISSUE 1 • 2018

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The emphasis tends to be on reducing the risk of BBP transmission, but in another case report, a dental hygienist working in a practice in Washington developed active tuberculosis (TB) and transmitted it to a co-worker. TB is passed through airborne transmission, where droplet nuclei can remain suspended in the air for many hours.2 According to the report, the dental practice had no personnel policies or administrative procedures in place for baseline TB screening or education. In addition, there were no records documenting whether dental staff members received baseline education about the signs and symptoms of TB.3 The risk of acquiring varied diseases or conditions as a dental healthcare worker is always present.

Reducing the risks To prevent the transmission of disease and infection, it is important to be ever vigilant in carrying out recommendations of the Centers for Disease Control and Prevention (CDC) regarding dental healthcare personnel safety and standard precautions. Standard precautions are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood,

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body fluids, non-intact skin and mucous membranes.4 The elements of standard precautions include: • Hand hygiene. • The use of personal protective equipment (PPE), including gloves, gowns and masks. • Safe injection practices. • Safe handling of potentially contaminated equipment or surfaces in the patient environment. • Respiratory hygiene/cough etiquette.5 Respiratory hygiene and cough etiquette are sometimes overlooked or minimized in the dental practice. However, especially now, when we are in the midst of cold and flu season, this is very important. Respiratory hygiene and cough etiquette, which were added to the list of standard precautions in 2007, are measures designed to limit the transmission of respiratory pathogens spread by droplet or airborne routes.6,7 The elements of respiratory hygiene and cough etiquette target patients (and anyone accompanying patients) who may have undiagnosed respiratory infections, as well as any dental team members with signs and symptoms of cough or congestion.7 The strategies ISSUE 1 • 2018 : 43

Infection Control downloadable posters on covering coughs for reception areas that are Key recommendations for respiratory informative and suitable for framing.8 hygiene/cough etiquette in dental settings The practice should have facial tissue, c. Provide resources for performing 1. Implement measures to contain waste baskets and alcohol-based hand hand hygiene in or near waiting areas. respiratory secretions in patients and d. Offer masks to coughing patients accompanying individuals who have sanitizers available to patients in the and other suymptomatic persons signs and symptoms of a respiratory reception area. Especially at this time when they enter the dental setting. infection, beginning at point of of year, the recommendation to offer e. Provide space and encourage persons entry to the facility and continuing with symptoms of respiratory infecthroughout the visit. masks to coughing patients and protions to sit as far away from others as a. P  ost signs at entrances with viding space to separate these patients possible. If available, facilities may wish instructions to patients with sympto place these patients in a separate toms of respiratory Infection to– from others in the reception area is an area while waiting for care. i. Cover their mouths/noses when excellent one. This demonstrates the 2. Educate DHCP on the importance coughing or sneezing. practice’s commitment to reducing the of infection prevention measures ii. Use and dispose of tissues. to contain respiratory secretions to iii. Perform hand hygiene after spread of respiratory infections to othprevent the spread of respiratory hands have been in contact ers, and patients and guests will defipathogens when examining and caring with respiratory secretions. for patients with signs and symptoms b. Provide tissues and no-touch nitely be appreciative of these efforts. of a respiratory infection. receptacles for disposal of tissues. The second key element emphasizes the education of dental healthCDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care, 2016; pg.9. care personnel on the importance of for implementation of this element of standard precautions containing and preventing the spread of respiratory pathois outlined below in the key recommendations from the CDC gens during the provision of dental care.7 It is vital that all team members are on the same page and understand the and is easily accomplished in practice. rationale for sound infection prevention measures to reduce The CDC’s Key Recommendations include two specific the risk of acquiring respiratory infections and cross-conto dental settings. The first focuses on ensuring the practice taminating patients. All elements of standard precautions has the appropriate protocol and armamentarium for patients, play a significant role in preventing disease transmission to or individuals accompanying patients, who have evidence of patients and dental team members. While there is a tendency respiratory infections. The practice should provide these perto focus on items such as hand hygiene and PPE, the recomsons with the necessary items and notices to ensure they are mendations for integrating respiratory hygiene and cough queued upon entering the practice. The reception area should etiquette into the dental setting are vital to complete the have signage reminding patients to cover coughs, use and entire picture in promoting patient and staff health. dispose of tissues, and perform hand hygiene. The CDC has References:

1. Cleveland JL, Gray SK, Harte JA, Robinson VA, Moorman AC, Gooch BF. Transmission of blood-borne pathogens in US dental health care settings, 2016 update. JADA, 2016. Accessed November 28, 2017. 2. Centers for Disease Control and Prevention. Tuberculosis. Accessed November 28, 2017. 3. Merte JL, Croll CM, Collins AS, Melnick AL. An epidemiologic investigation of occupational transmission of Mycobacterium tuberculosis infection to dental health care personnel. JADA, 2014. Accessed November 28, 2017. 4. C  enters for Disease Control and Prevention. Standard precautions for all patient care. standard-precautions.html. Accessed November 28, 2017. 5. C  enters for Disease Control and Prevention. Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. Accessed November 28, 2017. 6. C  enters for Disease Control and Prevention. Oral health; respiratory and cough etiquette. questions/respiratory-hygiene.html. Accessed November 28, 2017. 7. C  enters for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health, March 2016. 8. Centers for Disease Control and Prevention. Influenza; cover your cough. November 28, 2017.

Editor’s note: Dr. Katherine Schrubbe, RDH, BS, M.Ed, PhD, is an independent consultant with expertise in OSHA, dental infection control, quality assurance and risk management. She is an invited speaker for continuing education and training programs for local and national dental organizations, schools of dentistry and private dental groups. She has held positions in corporate as well as academic dentistry and continues to contribute to the scientific literature. 44

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Safest Dental Visit OSAP: An education resource for you and your group practice TM

Training opportunities, resources, compliance checklists and toolkits Understanding OSAP’s educational training opportunities, complimentary resources and membership benefits provides an opportunity to educate yourself, your practice and your patients.

The Organization for Safety, Asepsis and Prevention (OSAP) is a community of clinicians, educators, researchers and industry representatives who advocate for safe and infection-free delivery of oral healthcare. Focusing on strategies to improve compliance with safe dental practices and building a strong network of recognized infection control experts, OSAP serves as a leading provider of education to support safe dental visits and encourages you take advantage of the education tools.

Resources available to you now OSAP offers an extensive online collection of resources, publications, FAQs, checklists and toolkits that help dental professionals deliver The Safest Dental VisitTM possible for their patients. An example of curated information available to you now on is the OSHA Hazard Communications Standard Update: • View the OSHA Hazard Communications Standard Update. • Easily access a review of the key learnings for reference. • Find related articles, videos and FAQs.

Safety and the role of the infection control coordinator Did you know that while safety is the responsibility of everyone in the dental industry and community, the CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe 46

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Care Guidelines recommends having a written infection control program, evaluations, documentation and ongoing training on safety topics? To provide oversight of this program, it is also recommended that practices and organizations have an infection control coordinator (ICC). Often, these responsibilities are found in existing job titles, including dental assistants, office managers, OSHA coordinators, safety directors, etc. This means that in addition to established job duties, they must also have the knowledge, resources and time to successfully coordinate and provide accountability to the program. OSAP supports the duties of the ICC through comprehensive safety education resources and public campaigns, including Dental Infection Control Awareness Month.

Direct connection to decision and policy makers OSAP offers online and in-person education to help advance the level of knowledge and skill for every member of your team and the dental community. For example, hundreds of clinicians, educators, consultants, policymakers, industry representatives and ICCâ&#x20AC;&#x2122;s attended the

2017 OSAP Dental Infection Control Conference. On the cutting edge of dental infection prevention and safety education, attendees participated in sessions with infection control thought leaders and listened to presentations direct from CDC, FDA, OSHA officials, and other government agencies. The conference also serves as an important networking opportunity in dentistry with the latest products and innovations on display from exhibitors and sponsors. OSAP encourages you to attend the 2018 Dental Infection Control Conference in Dallas, Texas on May 31 - June 3, 2018. More information is available on the OSAP website, There are multiple ways for you to get involved with OSAP through membership and attending events. To learn more about how OSAP is the education resource for you and your group practice, visit

OSAP supports the duties of the ICC through comprehensive safety education resources and public campaigns, including Dental Infection Control Awareness Month.

ISSUE 1 â&#x20AC;˘ 2018 : 47

INDUSTRY NEWS Great Expressions Dental Centers promotes Greg Nodland to president, adds two new members to its leadership team Great Expressions Dental Centers (GEDC) recently announced the promotion of Greg Nodland to president. As president, Nodland will lead strategy surrounding the company’s continued commitment to providing high quality care to patients, as well as the Greg Nodland organization’s ongoing growth, according to a release. “Greg has been an integral member of Great Expressions’ executive team for nearly two decades and has been vital in the company’s rapid growth,” said Richard Beckman, CEO. “With his understanding of every aspect of our organization, knack for leadership and passion for delivering the Great Expressions quality of care to the communities we are privileged to serve, Greg is well-suited to lead our company as we seek to expand our practices and open in new markets in the coming years.” Nodland, 47, has served as GEDC’s Chief Operating Officer since 2013, where he was responsible for oversight of the company’s offices, office processes, regional directors and staff development. He joined GEDC in 1999 as vice president of finance where he led overall financial operations and managed IT and accounts receivable departments. During his tenure with GEDC, the organization has added over 250 offices and increased the number of patients it serves to 120,000 per month. A certified public accountant and graduate of Michigan State University, Nodland currently serves on the Winning Futures board. GEDC also added two new members to its leadership team: Adam Werder, chief marketing officer, and Norman Hartman, VP of revenue cycle management. 48

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Werder, previously director of sales and marketing at Bite Tech, first worked with GEDC through their rollout of Under Armour® mouth guards. He most recently served as vice president of marketing at Pet Supplies Plus. At PSP, he led the company rebrand and implemented automated marketing systems to improve operational efficiency and local marketing capabilities. In his role, Werder will lead all aspects of patient marketing and support business development and talent recruitment. A resident of Rochester, Michigan, Werder is a graduate of Yale University. Hartman brings to GEDC a deep knowledge and understanding of the insurance and patient billing process and has worked in the revenue cycle field for the past nine years. At GEDC, Hartman’s role will cover all insurance and accounts receivable functions. He will focus on building systems and processes to reduce denials, increase cash collections, and expedite accounts receivable. A resident of Macomb, Michigan, Hartman is a graduate of Western Michigan University.

Affordable Dentures & Implants partners with Brighter Way Institute Affordable Dentures & Implants will partner with Brighter Way Institute (Phoenix, AZ), for a nationwide program to deliver free dental implant, oral surgery, and prosthetic treatments to hundreds of U.S. military veterans and homeless citizens. Affordable Dentures & Implants has six Brighter Way events scheduled for this year. The company hopes to meet and exceed the more than $3.5 million in dental services it accomplished 2017. The Brighter Way Dental Institute, formerly known as the CASS Dental Clinic for the Homeless, provides comprehensive dental care and a dental home to homeless individuals as well as adults and military veterans, many of whom do not receive dental benefits through the U.S. Department of Veterans Affairs.

Brought to you by Share Moving Media DentalFacts was founded in 1994 to provide timely and accurate business and technical information to the worldwide dental industry. Today, Share Moving Media, your trusted providers of the Weekly Drill, First Impressions, and Efficiency in Group Practice magazines is carrying out this legacy and continuing to deliver the most up-to-date industry news!

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INDUSTRY NEWS Ivoclar Vivadent announces release of PrograMill™ One Ivoclar Vivadent announced the release of the PrograMill One milling machine, the compact, 5-axis milling machine designed to mill beautiful, esthetic IPS e.max restorations. The fresh design allows for high precision and convenience due to a self-contained milling system. This distinguishes it from other mills on the market that necessitate separate filtration or suction units. PrograMill One is wireless, which enables it to be positioned anywhere within the practice. It can be controlled using the mill’s corresponding app on a tablet or smartphone. An LED light ring visually informs the user about the current processing status. An innovative rotary grinding process, 5XT, produces shorter duration of the milling process and minimal tool wear. A camera integrated within the mill automatically records all data on material and tool use. Material management is more expedient than ever with PrograMill One. “5XT technology completely re-writes what milling machines are capable of in relation to machining times and superior outcomes,” said Robert Ganley, CEO of Ivoclar Vivadent. “The results are restorations with exceptional surface quality and excellent accuracy of fit. PrograMill One is an innovative addition to our line of Ivoclar Digital products, representing a significant leap in the future of dental technology.” PrograMill One’s smooth integration between wireless app and machinery combined with the auto connection capabilities with intraoral scanning partners, including 3Shape Trios, make it an unequaled asset for dental professionals seeking simpler milling methods and increased efficiency.

Aspen announces new offices in Illinois and Missouri Aspen Dental Management Inc (Syracuse, NY) announced it will open two new Aspen Dental-branded offices in Illinois. An office in Gurnee will open November 2 and an office 50

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in Joliet will open November 9. Aspen will also open two new offices in Missouri. One office will open November 9 in Arnold and another will open November 30 in St. Louis.

David Pegg joins Dental Care Alliance as Chief Development Officer Dental Care Alliance has hired David Pegg as Chief Development Officer. Pegg will lead the organization’s aggressive growth strategy to expand the number of dental offices it supports through mergers, affiliations, equity partnerships, and de novo opportuniDavid Pegg ties, according to a release. Pegg brings experience as an investor and advisor in the healthcare services industry for more than 20 years. He started his private equity career with MVP Capital Partners in Philadelphia and was recently a partner with Enhanced Equity Funds in New York. As part of his responsibilities, he has evaluated and been involved with numerous provider-based multi-site healthcare companies, including those in the dental space. “I am excited to have an executive of Dave’s caliber and capability lead our development team at DCA,” said Jerry Rhodes, the Chief Executive Officer at Dental Care Alliance. “Dave brings a wealth of skill, experience and relationships to our growth efforts. I am confident that under his leadership, DCA will continue to fortify its position as the partner of choice for dentists desiring to partner or affiliate with a dental services organization.”

UAMS awarded $118K for Dental Education The Office of Interprofessional Education (IPE) at the University of Arkansas for Medical Sciences (UAMS) received an $118,000 grant from the Delta Dental of Arkansas Foundation to create an oral health and dental education curriculum. The oral health component will be incorporated into the current IPE curriculum. Students in all degree programs at UAMS are required to take IPE courses. The curriculum will include training modules, live lectures and simulation activities, as well as screening events that will support preventive measures and identify patients in need of further intervention.

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Efficiency in Group Practice - janfeb18