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January/February . 2019

Editor’s Note

New Year, New Age............................................................................. 4

2019 ADSO Summit

Industry experts address topics critical to the growth and development of DSOs, including compliance, recruitment & retention, leadership and technology trends................. 6

A Foundation of Trust

EGP’s Dental Group Practice Summit unites industry leaders and vendor partners......................................... 8

Dealing with Toxic Coworkers .................................10 Products to Watch

The best products for your group practice now.................................14 • Crosstex, a Cantel Medical Company • NSK Electric Micromotor Saves Practices Money and Time • Palmero • ACTEON • Hager Worldwide • Preventech

• Hu-Friedy • Septodont • Shofu • MouthWatch • Zirc • Tuttnauer U.S.A Co., Ltd.

Infection Control in the Dental Practice: Questions to Ask.......................34 First Impressions

The look and feel of the reception area is important, but keeping it free of germs and infection is critical to the health of patients and staff..........................................36

Safe Water, Safe Patients

Growing attention to the hazards of contaminated dental unit water has led more dental clinicians to take the necessary steps to protect their patients...............................42

Biotec Custom Steri-Centers: Sterility assurance for any size practice.............45 Medical Waste Management....................................46 Create a Successful Hygiene Day

Five tips hygienists need to know and do..........................................50

Be the Leader They Want...........................................52 Industry News......................................................................54


Advanced technology, together with experience and a measure of sensitivity, enable pedodontists to provide the best possible care for their young patients...................................31 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.

EDITOR Laura Thill •




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 2019 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 • 2019 :


Editor’s Note

New Year, New Age Welcome to 2019 – and our annual Efficiency in Group Practice New Products Guide. It’s important to us to keep our readers abreast of the newest technologies and services, which they, in turn, can share with their patients.

Laura Thill


That said, not every dental patient is on board with the value of newer dental treatments – a continuous source of frustration for providers who genuinely care about their patients’ health. The good news is, based on current findings, it’s becoming difficult for the public to discount the importance of preventive dental care. As researchers continue to connect the dots between oral health (particularly periodontal disease) and other chronic conditions, such as diabetes, heart disease and asthma, payers, regulators and providers are getting the message. Patients will likely have a harder and harder time ignoring care and treatment. For instance, in October 2018, Dominion National, a dental insurer and administrator of dental and vision benefits headquarAs researchers tered in Arlington, Virginia, released a study indicating people with continue to chronic health conditions such as asthma, diabetes and heart disconnect the dots ease who received preventive dental care covered by Capital BlueCross’ BlueCross DentalSM benefits had fewer emergency room between oral visits and hospital stays. Before that, in September 2017, dental health (particularly insurer United Concordia released a study examining the mediperiodontal disease) cal benefit when an individual absent a chronic medical condition and other chronic regularly sees their dentist two times a year for checkups and cleanconditions, such ings, compared to those who do not. “The dental/medical connection has picked up momentum as diabetes, heart in the past two decades,” says Dominion National Vice Presidisease and asthma, dent of Marketing Jeff Schwab, whose company not only propayers, regulators vides dental and vision benefits, but administers dental benefits and providers are on the part of medical insurance providers. “Overall, oral health getting the message. professionals and physicians recognize the benefit of closing the information gap between them,” he says. Short of sharing patient records, primary care providers – particularly pediatricians – can continue to promote dental care to their patients; meanwhile, dentists can discuss the oral/medical connection to their patients, help detect signs of several chronic health conditions through oral exams, and refer patients to the appropriate healthcare provider. 2019 isn’t just a new year. It looks to be the start of a new age in dental healthcare.

Efficiency In Group Practice : ISSUE 1 • 2019

2019 ADSO Summit

Industry experts address topics critical to the growth and development of DSOs, including compliance, recruitment & retention, leadership and technology trends. The Association of Dental Support Organizations (ADSO) members will meet March 28-30, 2019, at the Manchester Grand Hyatt San Diego, San Diego, California, for the 2019 Annual Summit featuring presentations on advocacy trends, compliance best practices and the latest developments in the DSO industry. Following pre-conference events for industry partners in sponsorship roles and participating DSO representatives, the meeting will open with a Leadership Panel: CEO to CEO – New Horizons. Leadership Panel speakers included Steve Bilt, CEO, Smile Brands; Ken Cooper, CEO, North American Dental Group; Mitch Olan, CEO, Dental Care Alliance; and Dr. Sulman Ahmed, CEO, DECA Dental Group. The day will conclude with a sponsored Talk Table Exhibit and networking event, followed by a reception at San Diego’s Seaport Village headquarters. Guests will be invited to celebrate the opening of the ADSO 2019 Summit by exploring the 14-acre waterfront shopping hub and the dining and entertainment complex, modeled after a century-old harbor setting. Day two will open with breakfast and a Leadership Panel: Developing a C-Suite Leadership Team. Speakers include Pat Bauer, CEO, Heartland Dental; Alistair Madle, CEO, D4C Dental Brands; Bob Fontana, president and CEO, Aspen Dental Management; and Steve Thorne, president and CEO, Pacific Dental Services. Attendees will take advantage of a full day of presentations, featuring a range of topics and speakers: • Compliance: Victoria Harvey, SVP and chief legal 6

Efficiency In Group Practice : ISSUE 1 • 2019

o fficer, Smile Brands, and Dr. Andrew Matta, DMD, North American Dental Group. • DSO Models: Integrating Specialties. Merritt Drake, CEO, Rock Dental Brands. • Growth & Development: A Dentist’s Story: 1-25 Locations. Dr. AJ Acierno, CEO and president, DecisionOne Dental, and Dr. Jeremy Fry, CEO & CCO, Fry Orthodontics. • Leadership: Women in the DSO Industry. Dr. Yashu Singh, owner dentist, Sing Orthodontics. • Recruitment & Retention: How to Recruit & Attract Today’s Dental Students. Lisa Nguyen, program manager, UCLA School of Dentistry, Community Based Clinical Education, and Bill Piskorowski, associate dean, UCLA School of Dentistry, Community Based Clinical Education. • Technology: Foresight 20/20: Actionable Insights for Operations, Marketing & IT Success. Amol Nirgudkar, CEO, Patient Prism. • Clinical Systems: Creating a Culture of Clinical Excellence. Dr. Shalin Patel, chief clinical officer, DECA Dental Group. • Compliance: Building an Actionable & Practical Compliance Program. Andy Lyness, general counsel & chief compliance officer, D4C, and Dr. Rodney Alles, partner & chief of clinical affairs, DECA Dental. • DSO Models: One Size Does Not Fit All. Emmet Scott, CEO. Community Dental Partners.

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• Future Trends: Teledentistry. Brant Herman, CEO, MouthWatch, and Dr. Rick Workman, founder & executive chairman, Heartland Dental. • Growth & Development: Structuring for Growth, Scale & Sale. The Waller Law team. • Operations: Developing an Operational Infrastructure. Dr. Scott Luene, CEO, Breakaway Practice. • Advocacy: State and Federal Regulations – Impact on Today’s Dental Practices. Panel speakers. • Clinical Systems: Developing Doctor Protocols and Policy Manuals. Dr. Charlie Coulter, DDS, D4C, and Dr. Michael Acierno, president & chief medical officer, DecisionOne Dental Partners. • DSO Models: Emerging DSO Panel. Steven Jones, C-founder & chief development officer, CORDENTAL Group, and Brandon Halcott, president, Tru Family Dental. • Future Trends: The Future of Dentistry and its Impact on DSOs and Group Practices. Marko Vujicic, PhD, chief economist & vice president, American Dental Association.

• Marketing Panel: Bill Neumann, CEO, Group Dentistry Now; Paul Benson, senior consultant, Apex Revenue Technologies; Stacy Medena, creative manager, DecisionOne Dental Partners; Susan Schramm, marketing coordinator, DecisionOne Dental Partners. • Recruitment and Retention: John Whitaker, vice president, talent acquisition, DecisionOne Dental Partners, and Kristine Berry Hodson, Executive Coaching Medical/Dental. The closing reception that evening will be held at Petco Baseball Field. Guests who join the rooftop viewing party will enjoy watching the Padres play the San Francisco Giants. The closing general session on day three will feature internationally recognized artist, TED speaker and No. 1 bestselling author Eric Wahl. Wahl looks at the use of disruption as a competitive advantage, and his takeaway message is clear: If businesses don’t embrace innovation and creativity, they risk being left behind. For more information visit

ISSUE 1 • 2019 :


Dental Group Practice Summit

A Foundation of Trust EGP’s Dental Group Practice Summit unites industry leaders and vendor partners Efficiency in Group Practice, together with Share Moving Media, sponsored the Dental Group Practice Summit last November 8-9, at the Renaissance Atlanta Airport Gateway Hotel, Atlanta, Georgia. The Summit hosted a plethora of talented speakers, each bringing a unique voice of experience to the audience. Their message, however, was shared: Manufacturers and dental service organizations are more likely to establish a healthy partnership when the relationship is built on a foundation of trust, training and support.

Indeed, DSOs work hard to provide a fair and productive vetting process for potential manufacturer partners, and their guidelines and requirements should not be taken lightly. As for price? For the most part, the consensus suggested that price is only one of several factors, and is probably less influential than some might presume!

Speakers and topics Following a welcome and introduction, the sessions opened with a presentation by Dr. Michael Acierno, co-founder and chief medical officer, DecisionOne Dental Partners, and Dr. Jason Genta, vice president of clinical affairs, DecisionOne Dental Partners. The doctors discussed building effective relationships with group practices and competing with private labels, and shared their experience regarding what buyers look for. 8

Efficiency In Group Practice : ISSUE 1 • 2019

Later that day, Mortenson Dental Partners CEO Bill Becknell talked about the procurement process within Mortenson and its dental group practices. And, TruFamily co-founder and president Brandon Halcott spoke about the growing DSO, focusing on such points as vendor partnering opportunities, reasons for growing a DSO and strategies for navigating the purchasing process. Day One wrapped up with a panel discussion moderated by several key leaders, including Acierno, Genta, Becknell, Halcott and Kristine Berry, senior consultant, Dental Management Innovations, LLC and CEO, Women Rocking Leadership.

The following day featured a presentation by Berry, who addressed selling to groups, dentists and hygienists in an increasingly female-driven business. She also discussed myths about marketing to women and offered advice for lowering sales resistance and setting your organization apart from other businesses in the marketplace. Berry raised a number of important points, including: • Sales teams should be mindful, adjusting their approach and style for each customer. • Every situation calls for a new set of decisionmaking strategies. • Active listening is key to any sales team’s success. Final speaker Clair Diones, vice president of marketing and communications, Dental LifeLine, discussed how organizations can help provide care to those in need. The Summit concluded with a recap and Distribution Viewpoint Roundtable hosted by Share Moving Media.



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Practice Points

Dealing with Toxic Coworkers There’s one in every dental office. By Kristine Berry, RDH, MSEC, Executive Coach Kristine Berry has worked as a clinician, a dental board examiner, a dental operations executive, a practice management consultant, an educational manager for a global Fortune 500 company and an operational director, overseeing $23 million of revenue for dental service organizations in New Hampshire and North Carolina. Currently, she is a senior consultant, specializing in enhancing group practices. If you have a sticky situation at work, she invites you to contact her via email at


She’s the colleague who is always late to the huddle and never cleans her operatory on time. She’s apologetic, comes prepared with an excuse, and promises this will be “the last time!” You’ve been the nice guy, and have even covered up for her. But, now, you are sick of it. Or, in another scenario, this may be the coworker who takes credit for work you did. She steals your ideas and talks about you to others. A master of double-talk and double-dealing, she’ll deny everything and try to convince you – and others – that you’re the crazy one. You are angry and obsessed with her behavior, and sometimes you wonder if you are going crazy. The issue of problem coworkers has received less attention than that of managing a problematic boss of abrasive employees. Yet, in one study, 80 percent of people have reported that a single coworker has contributed significant stress to their workday. This stress isn’t just dangerous to employees; it has a negative impact on the entire dental practice and company. It can lead to poor work performance, absenteeism and health problems. Sometimes outstanding employees who see no solution to a toxic coworker look for a new job. In today’s competitive work environment, where finding and retaining talented people is increasingly difficult, this is a loss few dental groups can afford. Complaining to management or the owner about a problematic coworker is often ineffective and can backfire, making you look like the problem. But, there are some useful steps you can take to deal with this common workplace challenge. Remember, if you believe you have some control, you do.

Efficiency In Group Practice : ISSUE 1 • 2019




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Look first to yourself Are you the problem? Do you listen without interrupting? Do you take everything personally? Are you willing to change? Taking responsibility for your part will make it much clearer regarding how to proceed with a problematic peer.

Make sure this isn’t about a personality conflict or office politics Gender, race, culture and religion affect behavior in the workplace. What may be offensive to you may be reasonable to someone of another race, culture, generation or country/state of origin. For example, customs vary as to what is considered acceptable vs. abrasive behaviors. The rules of workplace behavior may have been hidden from co-workers, absent from professional resources or a result of family upbringing. Your coworkers may be unaware of the impact of their actions or words. Some may not have received the training or tools to resolve conflicts or issues. For example, one team member shared that growing up, she often laughed when disciplined, as it was a way to save face in front of her older siblings. In her world smirk or laughter was a go-to reaction, not a sign of insolence or insubordination. However, she brought this behavior into the office, and when her manager provided her with feedback, he believed she was uncaring and perhaps not a good fit for the practice. Understanding critical gender, racial and cultural disparities can provide a new perspective and lead to a conversation about expected professional behavior.

requests for help. A one-on-one friendly conversation in which you explain why this is a problem for you usually helps. Offering to go to lunch together, or scheduling time to talk, can help avoid turning a pesty colleague into an enemy. •C hallenging. This is a situation that requires more work on an ongoing basis. Take the coworker who turns every situation into a competition and can’t seem to grasp the concept of teamwork. In her book, Working with Difficult People, communications consultant Muriel Solomon strongly suggests immediately taking control when a coworker is deceitful, manipulative or exploitive. Stay calm, and be firm and up-front. Refuse to be drawn in, but state how

The issue of problem coworkers has received less attention than that of managing a problematic boss of abrasive employees. Yet, in one study, 80 percent of people have reported that a single coworker has contributed significant stress to their workday.

Classify the problem objectively Measuring the problem helps make it less threatening. Not every problematic colleague is the same. One approach is to identify whether this situation falls into one of three categories: difficult, challenging or toxic. Determining this will help you take the right steps. • Difficult. This is a situation that can usually be solved by a single action. For example, your coworker loves to schmooze and interrupts your workflow with comments, personal problems or

you perceive the problem as clearly and courteously as possible. Understand this behavior has insecurity and anxiety at the root. Reinforcing this person’s self-efficacy and self-confidence in their tasks might influence them to take more ownership of their actions rather than steal yours. You may have to repeat this several times as needed. • Toxic. Like some chemicals in the workplace, certain coworkers may be genuinely harmful to your health. In fact, these people are like a hidden cancer in the workplace, according to psychologists Alan A. Cavaiola and Neil J. Lavender. In their book Toxic Coworkers: How to Deal with Dysfunctional People on the Job, they list a range of personality disorders that, when taken to the extreme, can tear a workplace apart. Toxic behavior can consist of any action that creates emotional distress sufficient to disrupt organizational ISSUE 1 • 2019 : 11

Practice Points

functioning. Hence, a toxic co-worker is defined as any individual whose interpersonal behavior causes psychological pain in coworkers, sufficient to disrupt organizational operation. In extreme cases, abrasive behavior can impact productivity to the point of paralysis. In some cases, the best solution is to avoid the toxic person as much as possible, keeping all interactions matter-of-fact and brief. If that is not possible in your office, consider scheduling a time to speak with this person. If you are successful at creating self-awareness, which changes the toxic behavior, you and your co-workers’ suffering ends and the toxic person may

a. “I don’t want you to be perceived this way.” b. “These perceptions are doing you damage.” 4. Describe the perceptions as specifically as you can. a. “I observed that you do/say….” (Be direct.) 5. Avoid generalities, such as: “You are rude/ harsh/aggressive/insensitive.” 6. Describe the impact this person’s behavior has on others. a. “ When you don’t arrive on time for the huddle, I feel that you are treating us disrespectfully.” 7. Set consequences for further negative perceptions: a. “ If this continues, I will have to talk with our office manager, Cathy.” (Clearly state the consequence.)

In her book, Working with Difficult People, communications consultant Muriel Solomon strongly suggests immediately taking control when a coworker is deceitful, manipulative or exploitive. Stay calm, and be firm and up-front. even be grateful for your willingness to take the time to bring this to his/her attention. “It meant a lot that she cared enough to talk to me,” said one former toxic coworker after a teammate took her out to lunch.

Intervening conversation The following steps are designed to help ensure an intervening conversation is a win-win for everyone involved: 1. Describe the individual’s value to you as a co-worker; don’t bother intervening if they don’t have any value. 2. Explain that you believe you owe it to him or her to clue them in and make them aware of the growing problem. a. “I had a choice whether or not to talk to you about this, and I feel a responsibility to let you know about these negative perceptions.” 3. Explain that he/she is not the problem. Rather, negative perceptions about his/her interactions with others are the problem. 12

Efficiency In Group Practice : ISSUE 1 • 2019

If the situation is truly harmful, it may be time to talk to your manager or owner. Intervention at this level starts when the toxic employee’s supervisor sits down with this person to address his/her conduct. The intervention is similar in sequence to the above steps, but the supervisor has the authority to: • Determine conduct expectations. • Evaluate conduct. • Set limits and consequences for continued unacceptable conduct. • Offer help, such as training, specialized coaching or additional resources. • Monitor for improvement.

It is important to emphasize that speaking with, or coaching, a toxic employee assumes your office has a code of conduct and a culture intolerant of mistreatment. If this is not the case, you might consider the cost of staying vs. the costs of leaving. If you have no authority over the toxic co-worker who is making you miserable, and management refuses to intervene, or intervenes unsuccessfully, then another option is to consider other employment opportunities; buff up your resume, brush up on your networking skills and beef up your savings. Our jobs and careers are an integral part of who we are. Dealing effectively with problematic coworkers can help us maintain successful and satisfying work lives.

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Unbeatable results

Beautifil Flow Plus X ensures aesthetic, comfortable, long-lasting restorations – peace of mind for clinicians and patients alike. It’s not every day that St. Louis, MO-based Jack Griffin, DMD, discovers a restorative material that delivers outstanding clinical benefits – and then some. “All things being equal, I’ll select a composite restorative like Shofu’s Beautifil Flow Plus X, which not only features great clinical properties, but also has a positive impact on the patient’s oral environment,” he points out. With three dental practices, a team of 20 staff members and three doctors, and yearround teaching and lecturing commitments, he can’t afford to settle for anything less. Indicated for both anterior and posterior teeth, Beautifil Flow Plus X allows clinicians to place direct restorations with an excellent self-leveling ability and outstanding physical properties, equivalent to those of conventional hybrid composites. Its proprietary Giomer technology, now containing a patented nano S-PRG filler, benefits the adjacent tooth structure for sustainable caries prevention, while encompassing the ability to polish to a high and long-lasting luster. The trilaminar structure of the bioactive S-PRG filler particles forms a stable zone of interaction, designed to sustainably release and recharge at high concentrations. The S-PRG filler releases fluoride and other bioactive ions inhibiting plaque formation and minimizing postoperative hypersensitivity. In addition, the filler particles buffer and neutralize acids.

“Beautifil Flow Plus X Giomer technology releases ions, inhibiting plaque formation and reducing sensitivity for enhanced clinical performance,” Griffin explains. “In addition, my clinicians can count on unbeatable aesthetics and polish for excellent patient results. With two different viscosities (F03 self-leveling, and the stackability of the F00 no-flow), Beautifil Flow Plus X gives clinicians optimal choices to meet their handling needs. For my patients, that means aesthetic, comfortable, long-lasting restorations.”

Peace of mind “The versatility of Beautifil Flow Plus X is fantastic,” says Griffin. “We use it for many class 1 and 5 restorations, and as a liner to cover all dentin in larger, deeper restorations. “My clinicians appreciate the wide variety of colors and opacities Beautifil Flow Plus X offers,” he continues. “They can count on superior results, whether they are performing highly aesthetic anterior composites, masking dark roots, preps and posts, or performing posterior direct restorations. My practice has benefited from reduced inventory and lower clinical costs, and my dental team has peace of mind knowing our patients will be pleased with their restorations.”

Beautifil Flow Plus X: Unique design, enhanced properties Beautifil Flow Plus X is an injectable hybrid composite available in two different viscosities, F00 and F03, for restorative build-up and filling. The newly developed thin-walled needle tips facilitate application directly from the syringe, allowing clinicians to easily and smoothly

dispense the right amount of material at any time for precise direct restorations. Clinicians can take advantage of several latest-generation features, including: • I mproved mechanical properties. •O ptimal polishability and a durable luster.

• Uniquely designed needle tips that facilitate precisely shaped occlusal posterior restorations with no waste. • Nine common tooth shades, plus opaque dentin, enamel, bleach and effect shades.

ISSUE 1 • 2019 : 13

Products to


The best products Efficiency in Group for your group Practice asked a handpractice now ful of manufacturers about new products and services in 2019 that will help group practices improve care, and their bottom line. Here are their responses.


Efficiency In Group Practice : ISSUE 1 • 2019

“Safety is our best marketing tool” “When we designed our office, we put a large window in our sterilizing room. People asked why we wanted patients to see dirty instruments. Easy – we want them to see how effectively we practice and trust that everything is completely sterile for their safety. And because it’s unique and cool, their word-of-mouth becomes our best marketing tool.” Dr. Ileana T. Toro, DMD Dr. Junot J. Franco, DMD Village Park Advanced Cosmetic and Family Dental

Better care, by design Are you ready to design for safety? Midmark can help you design your clinical space to achieve the workflows you need, from your instrument processing area to your operatory. 1.800.MIDMARK |

© 2019 Midmark Corporation, Miamisburg, Ohio USA. All rights reserved.

Products to Watch

Crosstex, a Cantel Medical Company Crosstex Liquid Ultra™ Solution, an EPA-registered dental unit waterline treatment designed to kill biofilm bacteria in dental unit waterlines, is the only such product guaranteed to: • Kill biofilm bacteria. •R emove existing biofilm from dental unit waterlines (DUWLs). • Prevent and suppress the formation of biofilm in DUWLs.

• As a shocking solution. Liquid Ultra Solution may be used to rapidly treat waterlines prior to initiating a new treatment protocol or to quickly treat dental unit waterlines with extremely high CFU counts. For dental care providers unfamiliar with the term, shocking, it is a periodic method of rapidly treating dental unit waterlines – NOT evacuation lines – to remove bacteria and biofilm, as well as to slow the regrowth of biofilm. Following the application of the shock product, the residual product must be flushed from the dental unit waterlines prior to patient treatment. Dentists should ask themselves the following when considering Crosstex Liquid Ultra Solution: • What is our practice currently using to treat our waterlines? • Do we want a more automated waterline treatment like the DentaPure™ Cartridge, or would we prefer a more hands-on approach? • For dental practices currently using tablets, how often are you shocking your waterlines? What tablets do you use? (Shocking is a requirement for tablet use.)

Crosstex Liquid Ultra Solution provides multiple treatment options for bottle-fed systems to provide the flexibility that an office may need: •A s a weekly treatment. Think Pink Once a Week™! • In conjunction with a tablet protocol. Liquid Ultra Solution may be used as a shocking solution to ensure compliance with daily waterline treatment Instructions for Use (IFU). (It is important for tablet users to note that all tablet IFU require routine shocking on a periodic basis. Non-compliance with IFU required shocking protocols may result in CFU counts higher than they realize.) 16

Efficiency In Group Practice : ISSUE 1 • 2019

In highly publicized bacterial outbreaks in pediatric clinics in Georgia and California, Crosstex was called upon for guidance and remediation support. Liquid Ultra Solution, in combination with the installation of DentaPure Cartridges, was used to bring these clinics back into compliance, ensuring safe dental visits. The dental team should refer to the Liquid Ultra Solution IFU available at for precautionary statements, disposal and troubleshooting information. All product names are trademarks of Crosstex International Inc., a Cantel Medical Company, its affiliates or related companies, unless otherwise noted. Editor’s Note: Sponsored by Crosstex International Inc., a Cantel Medical Company.

NSK Electric Micromotor Saves Practices Money and Time In 2018 NSK America unleashed a powerful little micromotor (4.2 Ncm) that brought new technology, faster performance, a compact design and new safety checks; all this AND an unbeatable warranty.

Offices save time, money and frustration Electric handpieces are repaired less often than air-driven handpieces, usually by about half. If you repair air-driven handpieces every six months, your electric will be repaired about once a year. This saves employees time dealing with the repairs, shipping, etc. and it save the office in repair costs. All NSK products are covered by a Worry-Free Warranty. The NLZ Micromotor’s warranty is three years, and the premium Z95L (high speed) and Z25L (low speed) handpieces are 2½ years. No other company matches this warranty. And, it’s good for large practices.

Reduced risk of overheating One of the possible issues with handpieces is overheating, mainly caused by deterioration of the gears and a lack of proper maintenance. When used properly, the NLZ’s patented Contra-Check Function helps detect abnormalities prior to using the handpiece. The assistant sets up the operatory, attaches the handpiece and pushes a button to find out if it is ready to go or needs to be replaced before the doctor walks into the room. Again, this saves offices time, money and frustration. The NLZ Electric Micromotor has two versions: one with – and one without – endo function. The NLZ E Endo motor has both rotary and reciprocating functions

which allows it to work with DENTSPLY Sirona’s WaveOne® files. A large rotating angle in the cutting direction provides high efficiency, whereas a smaller angle in the reverse direction allows the WaveOne® file to safely progress along the canal path, while reducing the risk of a screwing effect and file breakage. This means greater safety and efficiency for endo procedures.

The innovative NLZ Electric Micromotor will win the heart of any practitioner looking for more power to rip through the tough restoration materials found in today’s dental market. Now cutting through zirconia and emax crowns can be done quickly and efficiently to the delight of patients and dentists alike, reducing chair time and the doctor’s arm fatigue. NSK America’s new NLZ can help any user of air driven handpieces convert to electric and enjoy the full benefits of this smart system. A big change in the treatment environment is brought with only a minor addition to the current equipment in your office. Editor’s Note: Sponsored by NSK America. ISSUE 1 • 2019 : 17

Products to Watch


Safety and infection prevention are crucial to any dental practice. When additional protection is needed to safeguard the entire face from infectious agents, the CDC suggests the use of a face shield. However, safety compliance can often be dependent on whether the product is comfortable for the clinician. At Palmero, we understand the importance of face shields and the need for comfort and reliability to safeguard the entire face from infectious agents. Palmero’s Dynamic Disposables™ Snapeez™ Face Shield offers the ultimate in Personal Protective Equipment, meeting both CDC and OSHA bloodborne pathogen guidelines. It’s the next generation of face shields, with an easy-to-use, snap-on disposable 18

Efficiency In Group Practice : ISSUE 1 • 2019

lens that provides a self-sealing face shield, preventing exposure to bloodborne pathogens. The Dynamic Disposables Snapeez Face Shield is lightweight, disposable and cost effective, offering extremely comfortable coverage. Unlike some systems that use an eye glass style frame to support the shield, the Dynamic Disposables Snapeez Face Shield delivers a more comfortable and secure fit. In addition, its ultra-light-weight frame does not require a cumbersome nose bridge. The reusable wraparound ergonomic frame design allows the face shield to be worn with or without prescription eyewear. Both the full- and half-shield sizes have Ultra-Clear™ Technology to prevent


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Introducing Palmero Healthcare’s newest safety eyewear to enhance eyesight protection and comfort for safety compliance for your practice, staff, and patients. Our safety eyewear meets ANSI Z87.1 eye and face protection standards with UVA and UVB protection.


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* To receive your no charge item(s), please email a copy of your dealer invoice dated 01/01/19-03/31/19 to:, fax to (203) 377-8988, or mail to: 120 Goodwin Place, Stratford, CT 06615. Must receive invoice by 04/30/19. Please allow 4–6 weeks for no charge goods. Offer only available for continental U.S.

fogging, glare and static electric buildup. The crystal-clear plastic allows for excellent front and peripheral vision with protection dental care providers can trust. Because it is disposable, the shield is guaranteed to be scratch free for optimal visibility. Dentists considering the Dynamic Disposables Snapeez Face Shield should familiarize themselves with CDC guidelines that state, “Dental health care personnel should wear protective eyewear with solid side shields or a face shield during procedures likely to generate splashes or sprays of blood or body fluids or the spatter of debris.”

Both the full- and half-shield sizes have Ultra-Clear™ Technology to prevent fogging, glare and static electric buildup. The crystal-clear plastic allows for excellent front and peripheral vision with protection dental care providers can trust.

Some dentists may have a few concerns, such as: • “I wear loupes. Will they fit? • Dynamic Disposable Snapeez are compatible with most average loupe sizes, giving clinicians

wraparound protection meeting OSHA and CDC guidelines and protecting against splashes, sprays and splatter from bloodborne pathogens. Compliance is now stress-free and easier than ever before with Dynamic Disposables Snapeez. The snap-on shield is easy to use and remove, making enhanced safety a simple choice for your practice. Editor’s Note: Sponsored by Palmero. ISSUE 1 • 2019 : 19

Products to Watch

ACTEON The Piezotome™ CUBE is a brand-new ultrasonic bone surgery device designed to provide superior, minimally invasive, compassionate care when performing extractions and other pre-implant bone surgery procedures. The high-frequency, ultrasonic vibrations of the CUBE disrupt the PDL and cut bone without damaging soft tissue, making it especially effective with ankylosed teeth. The extremely thin extraction tips preserve even the thinnest of bone in the buccal area for socket preservation and to facilitate immediate implant placement. Patients experience less trauma, less pain and less swelling post operatively compared to other methods, such as burs or manual forceps, potentially reducing the need for opioids and other dangerous pain medications. The CUBE is designed to grow with the dental practice, with tips for such applications as bone block grafting, sinus elevations, ridge splitting and crown lengthening. The CUBE is a must for any clinician placing dental implants or looking to keep challenging extractions in-house. Powered by the Dynamic Power System Inside (DPSI), the CUBE’s power can be increased by 30 percent, or decreased by 10 percent, making it the most powerful handpiece available, with the capacity to provide the gentlest treatment when necessary. The LED-lit handpiece weighs 20 percent less than other comparable units, for superior ergonomics and unsurpassed visibility in posterior areas. Touch-screen operation ensures precise control of power and irrigation. Dentists should ask themselves the following when considering the CUBE: •H ow do I currently perform atraumatic extractions, or extractions followed by immediate implant placement? • How do I preserve the socket during atraumatic extractions? • How do I perform bone grafting procedures? • How could my patients and my practice benefit from a new and faster way to perform these procedures, with less trauma to patients? 20

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Some dentists may have a few concerns, such as: • “I can’t afford to pay $7,200 for an extraction machine.” • A CUBE costs more compared to a pair of forceps or a high-speed handpiece. But, with the versatility to perform bone block grafting, crown lengthening, sinus elevation (internal and lateral) and ridge splitting, it’s much more than an extraction machine. And, is it possible to put a price on decreased patient trauma, increased patient comfort, easier-to-perform extractions and better outcomes? • “I need more time to consider such a large investment.” • This is an investment with a quick ROI. If you perform five extractions each week, at an approximate cost of $90 per extraction, the practice will break even after 80 extractions, or 16 weeks. (Keep in mind the ROI is faster for a practice that performs more surgical extractions, which are more expensive.) The Piezotome™ CUBE from ACTEON provides less trauma and less drama for patients and clinicians alike. Learn more at or set up a demo at Editor’s Note: Sponsored by ACTEON.

Hager Worldwide The One Touch Revolution is a topical anesthetic gel that offers practical benefits for both the clinician and the patient. The 20-percent benzocaine formula provides fast and temporary relief, and the unique pump-action jar dispenser delivers the exact amount of gel needed with every application. Clinicians waste less and save money. As an added benefit, only a single pump is needed to treat a quadrant, and the pump seals off the dispensed material from the remaining contents, helping reduce the risk of cross-contamination. Even better, patients will appreciate the comfort provided by the fast onset, as well as the two pleasant flavors of strawberry ice and cool mint. Dentists should ask themselves the following when considering the One Touch Revolution: • How is my topical anesthetic currently dispensed? • Am I finding it difficult to prevent more anesthetic than I need from coming out of the dispenser? Some dentists may be concerned that One Touch Revolution costs more than their current brand of anesthetic. However, One Touch Revolution ensures a lower cost per use, since the efficient dispensing method yields more applications. Dentists can count on greater convenience, improved efficiency and better patient results. Editor’s Note: Sponsored by Hager Worldwide. ISSUE 1 • 2019 : 21

Products to Watch


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, adding if a semi-critical 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. This isn’t a recommendation. It’s the law. With infection control and sterilization of instruments becoming more transparent to patients, more states may be on the verge of adopting similar mandates. ēsa fits a number of heat-sterilization-tolerant handpieces: Midwest® Shorty®, Rhino®, Star® Titan and our ēsamate® lube-free handpieces. Because ēsa® eliminates the nose cone, it’s 50 percent lighter and costs less to use than traditional handpiece 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. Both handpieces feature proven air-driven performance. No recharging or batteries required! They run at

5,000 rpm, which is perfect for prophys, and are backed by a 2-year warranty. Some points to consider about CDC compliance include: • How does my practice handle infection control procedures for low-speed or dental hygiene handpieces? • Do we heat sterilize our low-speed handpieces after each patient? • Are our low-speed handpieces heat-tolerant? • What types of low-speed handpieces do we use? Some dentists may have a few concerns, such as: • “It’s too costly to purchase the necessary number of handpieces to ensure compliance with heat sterilization recommendation or requirements.” • The CDC Guideline states, “If a semi-critical item does not come in contact with mucous membranes or non-intact skin,” heat sterilization is NOT required. In these states, using an ēsa® DPA, along with a plastic barrier on the handpiece, cuts the cost on infection control in half. For samples of the ēsa DPA, or for more information, visit Editor’s Note: Sponsored by Preventech.

References: 1 “Summary of Infection Prevention Practices in Dental Settings” Centers for Disease Control and Prevention, March 206, P14. 2 State Dental Practice Boards in CA, FL, KS, OH, OR, SC, VA and WA require semi-critical items be sterilized after each patient.


Efficiency In Group Practice : ISSUE 1 • 2019

Reduce the Cost of Handpiece Infection Control Compliance

ēsa brings your practice 100% compliance at 50% of the cost¹ Let’s simplify the CDC recommendations. If a semi-critical item (i.e., low speed handpiece) is heat-tolerant, it should be sterilized between patients. If it’s heat-sensitive, you should not use it: Instead, replace it with a heat-tolerant or disposable alternative.² Since replacement can be costly, talk to us about ēsa and the compliant, cost-effective ēsamate prophy system. ēsa disposable prophy angles fit the Midwest Shorty®, Rhino® and Star® Titan® handpieces.3 So, if you already own these handpieces, put an ēsa on them and be compliant wherever you work.

If not, consider our ēsamate ST and new ēsamate MW lube-free low speed handpieces. • Both are heat sterilization tolerant, 5,000 rpm, and backed by a 2-year warranty • Both offer proven air-driven performance; no recharging or batteries • Both are lightweight with a 360° swivel Best of all, both offer a simple, cost-effective solution to handpiece infection control compliance in all 50 states. To learn more, call us at 800-474-8681 or visit

4330-C Matthews-Indian Trail Road • Indian Trail, NC 28079 • 800.474.8681 • 704.849.2416 • fax: 704.849.2417 • 1 Cost comparison based on Henry Schein Dental website prices and promotions for ēsamate® and Nupro Freedom® Handpieces as of August, 2018. 2 “Summary of Infection Prevention Practices in Dental Settings,” Centers for Disease Control and Prevention, March, 2016. Page 14. 3 ēsa is available for Star Titan, Midwest Shorty and Rhino. All third party marks - ® and ™ - are the property of their respective owners.

Products to Watch

Hu-Friedy Sharp scalers are a necessity in any office, allowing clinicians to be more efficient and improve comfort for both themselves and their patients. However, heavy schedules and growing daily responsibilities often result in dull scalers piling up, and there never seems to be enough time or staff to address this. Furthermore, the more time the dental team must spend sharpening instruments, the less time they have to care for patients. Hu-Friedy estimates the annual cost for one hygienist to spend one hour sharpening each week is close to $11,650.* Sharpening can be confusing and burdensome, but Hu-Friedy has developed a solution: the EverCare Scaler Sharpening Service. EverCare is a subscription-based service to assist with ALL Hu-Friday scaler sharpening

needs. EverCare saves time by crossing sharpening off the to-do list. EverCare is convenient and simple to use, taking the task of sharpening out of the hands of hygienists while increasing practice efficiency. The EverCare Sharpening Service maintains that perfect edge on scalers, creating a great patient experience without losing billable hours. Submitting an online order is quick and easy and a prepaid mailing label is promptly sent after order submission to send in the dull scalers to be sharpened. Expert artisans sharpen the instruments, restoring the blade to the sharp and pristine condition that Hu-Friedy scalers are known for. With EverCare, ground shipping is free and turnaround is fast. Instruments are inspected and sharpened in 3 ½ business days, ensuring practices can maximize the time their sharp instruments are in rotation. With EverCare, there are six flexible membership levels to choose from, including pay-as-you-go and all-inclusive options. The EverCare website also offers a unique calculator* tool to help evaluate the increased profit Hu-Friedy can bring to your practice. (*Hu-Friedy Financial Savings Tool – financial-savings) With the EverCare Scaler Sharpening Service, dental offices will increase efficiency, maintain the highest quality of instruments, save money and generate more revenue by allowing clinicians to spend more time with patients. Stay sharp and get started today at www. Editor’s Note: Sponsored by Hu-Friedy.


Efficiency In Group Practice : ISSUE 1 • 2019

Septodont Performing the right injection is the first step toward a pain-free patient experience. Anesthesia is a first and essential step for most dental procedures. But dentists face a variety of issues when using a traditional syringe, such as: • Adhering to the recommended injection time (One milliliter in one minute). • Variations in pressure, which can damage tissue and cause discomfort to the patient. • Keeping the quality of injections consistent throughout the day. With the Dentapen, these challenges are greatly reduced. Dentapen is a new generation of electronic syringe to perform pain free injections. Like most electronic syringes, the Dentapen injection is monitored with a constant flow, at the right pace. This gives dentists the opportunity to focus more on needle insertion1, leading to better control of the injection and a reduction in pain for the patient. For instance, during a study done on 50 dentists

who received a palatal injection, 96 percent of them preferred injections from an electronic syringe vs. manual syringe, and their pain perception was reduced by a factor of two2. What makes the Dentapen different is that it is a self-contained, cordless, intuitive device that matches dentists’ habits. There is no console, no foot pads, and no tubing or proprietary disposables. It can be held in two different ways – by the wings, like a manual syringe, or pen-like, for a precise injection during special procedures. Dentists can use any local anesthetic cartridge and their favorite dental needle. And patients find the small, modern look to be less threatening and more reassuring, helping them to relax. For over 80 years Septodont has been a global influence in manufacturing dental materials and local anesthetics for the dental community. Today they are a leader in pain management with a presence in over 150 countries with regulatory approvals to match. For more information, visit Editor’s Note: Sponsored by Septodont.

References: 1. Hochman, MN, Chiarello D, Hochman CB, Lopatkin R, Pergola S. Computerized Local Anesthesia Delivery vs. Traditional Syringe Technique. NY State Dent J. 1997; 63:24-9.

ISSUE 1 • 2019 : 25

Products to Watch

Shofu Beautifil Flow Plus X, a durable NEW UPDATE to the latest-generation composite restorative, indicated for both anterior and posterior teeth, allows clinicians to place direct restorations with an excellent self-leveling ability and outstanding physical properties, absolutely equivalent to those of conventional hybrid composites. Thanks to its proprietary Giomer technology, NOW containing a patented nano S-PRG filler, Beautifil Flow Plus

X benefits the adjacent tooth structure for sustainable caries prevention, while encompassing the ability to polish to a high and long-lasting luster. The trilaminar structure of the bioactive S-PRG filler particles forms a stable zone of interaction, designed to sustainably release and recharge at high concentrations. The S-PRG filler releases fluoride and other bioactive ions inhibiting plaque formation and minimizing postoperative hypersensitivity. In addition, the filler particles buffer and neutralize acids. 26

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A complete system for all indications Beautifil Flow Plus X is an injectable hybrid composite available in two different viscosities, F00 and F03, for restorative build-up and filling. The newly developed thin-walled needle tips facilitate application directly from the syringe, allowing clinicians to easily and smoothly dispense the right amount of material at any time for precise direct restorations. Beautifil Flow Plus X F00 (Zero Flow) and F03 (Low Flow) both provide optimal viscosities for anterior and posterior restorations. The flowability of F00 (Zero Flow) is so low that the material does not slump during layering. This easy-to-handle composite helps clinicians accurately restore the occlusal morphology, including cusps and marginal ridges. It flows well during application and has excellent shape retention while sculpting. By comparison, the self-levelling F03 (Low Flow) paste thoroughly wets the cavity walls, making it an ideal solution for filling. It can be used to line cavity floors, fill small occlusal cavities or create cervical restorations. Beautifil Flow Plus X features improved mechanical properties, optimal polishability and a durable luster. Simple final polishing and excellent physical properties ensure superior long-term results. The unique design of the needle tips ensures the paste neither sticks to the needle opening nor oozes at the end of delivery. Clinicians can easily and precisely shape occlusal posterior restorations without wasting material. A reliable, state-of-the-art restorative system, Beautifil Flow Plus X includes nine common tooth shades, plus opaque dentin, enamel, bleach and effect shades, characterized by exceptional shade stability. This assortment covers all indications of direct restorative dentistry, allowing clinicians to meet all aesthetic requirements in both multi and single-layer techniques. Editor’s note: Sponsored by Shofu.

warning: High gloss distraction

Beautifil Flow Plus X A Nano-Hybrid Composite with Fluoride Release & Recharge Achieves more surface gloss in less time—effortless polishing

Improved handling

Stackable & sculptable; stays put

Chameleon effect—aesthetically blends with the natural tooth

High flexural strength

Low wear resistance & shrinkage

Indicated in classes I, II, III, IV & V



Dr. Howard Glazer, Fort Lee, New Jersey

Shofu Dental Corporation | San Marcos, CA | 800.827.4638

Products to Watch

MouthWatch Patients trust pictures! Photographs are easy to understand, even for those without clinical expertise. MouthWatch has created an affordable intraoral camera that produces high-quality diagnostic images. Patients will have a better grasp of the treatment they require, permitting dentists and hygienists to become solution providers, rather than having to sell patients on the need for treatment. In addition, the dental practice is guaranteed seamless integration with its imaging software. And, single-button operation makes intraoral photography efficient and easy for the entire team to use.

• Ease of use. Clinicians save time with every patient interaction. One quick, lag-free click on the capture button saves intraoral photos straight to the patient’s chart. No keyboard or mouse clicks are involved. • Lifetime customer support. It doesn’t take an IT person to set up a MouthWatch camera. Should the dental practice encounter a problem, the MouthWatch team is available by live chat, phone or email to quickly find a solution. • Instantaneous capture. There’s no such thing as having to wait for a MouthWatch intraoral camera to warm up. The clinician can capture images immediately. • Money-back guarantee. The MouthWatch one-year warranty, 30-day no-risk satisfaction guarantee and lifetime technical support ensure clinicians can depend on their intraoral camera to perform as it should. Dentists should ask themselves the following when considering the MouthWatch intraoral camera: • How do I currently present cases to my patients? • Do I have a camera in every operatory? • Are cameras a part of my standard workflow with new patients?

When a dental practice adds a MouthWatch intraoral camera, it can count on a number of benefits, including: • Crystal Clear Images. Dentists can capture clearly illuminated, diagnostic quality images with the press of a button. • Easy integration. The MouthWatch intraoral camera integrates seamlessly with all popular imaging software, including Eaglesoft, Dexis, Schick, Apteryx. • Ergonomics. Weighing in at 31 grams and boasting an ergonomic handle, the MouthWatch intraoral camera is designed for ease of use with every patient, all day long. • Precise focus. The camera’s fixed-focus lens ensures clinicians spend no time focusing it manually, and avoid the frustration often associated with the auto-focus hunting. 28

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Some dentists may have a few concerns, such as: • “We’ve had integration issues with previous cameras.” • MouthWatch intraoral cameras are guaranteed to integrate with all imaging software. In addition, MouthWatch offers lifetime technical support. • “Our previous cameras have had full-face mode or auto-focus, which hasn’t been easy to use.” • MouthWatch intraoral cameras feature fixed-focus, which is sharp and saves time. MouthWatch does not charge monthly fees for support or upgrades of capture software. There are no license restrictions. Editor’s Note: Sponsored by MouthWatch.


Did you know that dental items have been reported to be the second most common foreign object ingested or aspirated by adults? Zirc has developed Airway Armor, an innovative safety device designed to protect the patient’s airway. Airway Armor is the first of its kind on the market to serve as a barrier to swallowing or aspirating objects, allowing dentists to practice safely and confidently. This latex-free safety device is disposable and serves as a stable, comfortable, protective barrier in the mouth. It is easily placed and retrieved and is invaluable in all situations where other protective barriers are not viable options. Airway Armor is a safe alternative to gauze packs, which typically cause patients discomfort. In addition, gauze packs can be difficult to place, absorb moisture and frequently need to be replaced. They have also been known to become lodged or aspirated into the airway, causing unnecessary risk to the patient. By contrast, Airway Armor is easy to place and durable, while giving practitioners full-mouth accessibility. It is available in three sizes – small, medium and large – to ensure a proper fit for any size mouth. Dentists should ask themselves the following when considering Airway Armor:

• Is my practice doing procedures that expose our patients to the risk of ingesting or aspirating a dental object? • What precautions do we take to protect our patients and our practice during these procedures? Some dentists may have a few concerns, such as: • “Will it make my patients gag?” • Flexible, yet durable, Airway Armor can be positioned within the mouth to keep most patients comfortable without gagging. • “Why is the cost so high for a disposable item?” • Although Airway Armor is disposable, it is made of a durable material uniquely engineered to ensure its comfort, fit and effectiveness. It’s a simple, worthwhile precaution that can protect the practice from a costly malpractice lawsuit. Airway Armor gives practitioners and patients alike peace of mind during treatment, including extractions, implants, restorations, orthodontics and pediatric procedures, by enabling them to provide the safest possible care to their patients. Editor’s Note: Sponsored by Zirc. ISSUE 1 • 2019 : 29

Products to Watch

Tuttnauer U.S.A Co., Ltd. Committed to better dentistry Dental teams today face challenging sterilization workloads and strict regulatory requirements, making it more important than ever before to depend on a sterilizer that delivers optimal results, without sacrificing convenience. At Tuttnauer, our single focus on sterilization and infection control enables us to offer products to help practitioners

meet today’s challenging workloads and regulatory requirements. The EZPlus series fully automatic sterilizers meet the most current sterilization standards ANSI/AAMI ST55. Both 9-inch and 11-inch models feature the dynamic air removal technology and an active closed-door HEPA filtered air-drying system to maintain sterility and ensure efficient drying of packs and pouches. In addition, the door remains closed throughout the dry cycle, encouraging the staff to leave the pouches/packs in the unit until all items are completely dry. This very important feature helps ensure the safety of patients, staff and doctors. Dentists who are considering adding the EZPlus series should ask themselves several questions: • How old is my sterilizer? Is it time to replace it? • What type of sterilizer am I comfortable using? What model am I replacing and what chamber size does it have? 30

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• Does my current model sterilizer meet all of the needs at my office? • Does my office need to change from a manual autoclave to a fully automatic system? Will doing so free up time for the staff to work more closely with patients and assist with procedures that add to the bottom line? • Has the volume of items to be sterilized at my office increased, decreased or remained the same? Do I need a larger, smaller or equivalent chamber size than I currently have? Some dentists may question the best way to maintain an EZPlus autoclave: • Regular cleaning and maintenance of a sterilizer is critical to keep the device in good working condition. • Do not overload the sterilizer trays. Overloading sterilizers is the number one cause of sterilization cycle failures, including inadequate sterilization and drying. • When using pouches, do not overlap or stack the pouches. Place pouches on trays in a single layer or use a pouch rack. • Always use steam-distilled water with the physical characteristics detailed in the sterilizer manufacturer’s operator’s manual. Tuttnauer is the only manufacturer to offer a twoyear warranty on parts and labor, as well as an additional 10-year warranty on the chamber for all of its fully automatic autoclaves. Editor’s Note: Sponsored by Tuttnauer U.S.A Co., Ltd.

Specialty Focus: Pedodontics

Pedodontists Advanced technology, together with experience and a measure of sensitivity, enable pedodontists to provide the best possible care for their young patients.

For pediatric dentists, patient care can be a fine like pediatricians. Our goal is to provide a dental home balance between treating a child’s oral health and creating for each child.” a safe, welcoming environment. The recommended age The battle against tooth decay for a child’s first dental visit has dropped from three years Pediatric healthcare can be frustrating, both for parents who to 12 months in recent years, making it more important wish for immediate results for their children, and clinicians than ever before for pedodontists to determine a treatwho are always in a position to deliver. “Dental caries is still ment plan tailored to each patient’s needs. the most prevalent childhood disease Indeed, pedodontists must we see, even in our affluent society,” approach their patients with a unique says Hansford. Most people’s diet level of clinical experience that enables includes processed foods, with lots of them to manage each child’s behavrefined carbohydrates, she points out. ior while also assessing his or her “Even crackers break down on the growth and development. “It is teeth into simple sugars, which can important that we meet each child cause decay. to determine his or her needs for “Parents become frustrated,” behavioral management, and put she continues. They feel they are together a treatment plan that best doing everything they can to prosuits that child,” says Kim Hanstect their child’s teeth, but to no ford, DMD, a pediatric dentist at avail, she notes. While good nutriMiddletown, Kentucky-based Kid's – Kim Hansford, DMD, a pediatric tion helps children avoid tooth Dentistree, a Mortenson Dental dentist at Middletown, Kentuckydecay, there often are overlooked Partners partner. “We see ourselves based Kid’s Dentistree and a consultant with Mortenson Family Dental culprits that impact oral health. as primary care providers, much

“It is important that we meet each child to determine his or her needs for behavioral management, and put together a treatment plan that best suits that child.”

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Specialty Focus: Pedodontics

Medications are a prime example, she points out. “A liquid allergy medicine taken every night by a child has sugar in it,” she says. “Gummy vitamins are made with sugar and stick to the teeth. “Grazing or snacking – and not letting the mouth have time in between snacks or drinks to normalize – can place children at high risk, due to repeated exposure. It is my job to provide parents with the tools they need to avoid these easy traps, and teach them to care for their child’s teeth at home.

options for pediatric patients, and the pedodontist can determine the best method for each patient. “Some children may do great in a pediatric dental setting without any additional medications,” she points out. Equipment such as digital imaging/radiographs are another must-have for pedodontists. “Developments in digital imaging greatly reduce children's exposure to radiation while delivering excellent clinical X-rays,” she explains. “We make a commitment to image gently in our office.” Without radiographs, pedodontists cannot determine an exact number of cavities, she adds. “Hidden interproximal decay can be a big surprise to parents!” Hands-free dental vacuum suction and isolation systems have “totally changed the way I practice pediatric dentistry,” says Hansford. “In the past 20 years, this technology has allowed pedodontists to provide treatment on one whole side of the mouth safely and comfortably, with less local anesthetic than in the – Kim Hansford, DMD, a pediatric dentist at Middletown, KY-based Kid’s past when we relied more on rubber Dentistree and a consultant with Mortenson Family Dental dam isolation. “Dental materials have also Exceptional technology come far, allowing pedodontists to provide more esthetic “Unfortunately, there is no magic bullet for treating chiloptions, in more instances than in the past. Glass ionodren,” says Hansford, noting she makes a point to put mer restorations in children provide fluoride release, good herself in these parents’ shoes and be sensitive to their esthetics and are more tolerant in moist environments, expectations. That said, pedodontists today have some where perfect isolation may not be achieved. exceptional technology at their disposal for treating “General public awareness of the importance of early patients, she adds. evaluation is key in helping children get established in a For many years, nitrous oxide has proved itself invaludental home and hopefully lowering their risks of oral able in many dental settings, but particularly in pediatric health issues,” Hansford continues. Children may always practices. “Nitrous oxide sedation continues to be the safest have caries, she adds. But, with new treatments like siland most predictable way to provide an easier experience ver diamine fluoride as an adjunct therapy to delay treatfor most children,” says Hansford. “We use it for patients of ment, or decrease need in times where it may not be pracall ages; it can make or break a child's experience under the tical due to the patient’s medical status or very young age, right circumstances.” She advises dental professionals against pediatric dental practices should have greater opportunity using the term sedation too freely. There are a number of to take a preventive stance to oral healthcare.

“ General public awareness of the importance of early evaluation is key in helping children get established in a dental home and hopefully lowering their risks of oral health issues.”


Efficiency In Group Practice : ISSUE 1 • 2019

Seeing is believing. See for yourself, request a demo today.

Achieve optimal visibility, moisture control, improved eďŹƒciency, and consistent results, while providing patients with comfort and safety. See for yourself and learn how an ISOLITE 3 can complement your dental practice. Request your free demo todayďŹ demo


Safest Dental Visit


Infection Control in the Dental Practice: Questions to Ask Are dentists and their staff taking proper precautions to prevent cross-infection in the dental office? OSAP has prepared the following checklist. Answers are drawn from current dental infection control recommendations from the Centers for Disease Control and Prevention (CDC), the American Dental Association (ADA), and OSAP.

1. Do you heat-sterilize all your instruments, including handpieces, between patients? In keeping with Centers for Disease Control and Prevention, American Dental Association and OSAP recommendations, dental care providers should be heat-sterilizing all instruments that penetrate or contact a patient's oral tissues. Although autoclaves are most commonly used to sterilize dental instruments, some offices may have other types of heat sterilizers. Chemical-vapor sterilizers (chemiclaves) and dry-heat sterilizers also are appropriate for sterilizing dental instruments. The dental team should heat-sterilize instruments that have been used on a patient before they are introduced to treat the next patient. 34

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Most dental instruments are designed to withstand repeated heat sterilization.

2. How do you know that the sterilizer is working properly? Most practices use a variety of methods to ensure that the office sterilizer is doing its job. In addition to monitoring the sterilizer's gauges and readouts for proper temperature and (for autoclaves and chemical-vapor sterilizers) pressure, the dental team should wrap and seal instruments in packaging equipped with a chemical that changes color on exposure to heat and/or some other combination of sterilizing conditions. These colorchange indicators also help to identify instrument packages that have been sterilized, so there's no chance that contaminated instruments could inadvertently be selected to treat the next patient. In addition, the dental team should routinely test their sterilizer using a vial or envelope containing spores. Called biologic monitoring, subjecting commercially prepared, sealed spore strips or vials to a sterilization cycle, then culturing the spores to ensure they have been killed, is the highest guarantee that a sterilizer is functioning and being utilized properly. Most practices use biologic monitoring weekly or monthly in combination with color-change indicators on each instrument packet and monitoring of the sterilizer gauges and readouts.

3. Do you change your gloves for every patient? Every dental care provider should use new gloves for each and every patient. For procedures that are likely to

involve splash or spatter, the dental team will also don a new mask, as well as wear protective eyewear and apparel (possibly a gown or clinic jacket).

4. Do you disinfect the surfaces in the operatory between patients?

Most practices choose to cover some surfaces and disinfect others between patients. Some practices disinfect all surfaces between patients; others use protective barriers for all surfaces in the treatment room. OSAP focuses on strategies to improve compliance with safe practices and on building a strong network of

Between patients, the dental team should disinfect all surfaces they are Between patients, the dental team should likely to touch during treatment. This disinfect all surfaces they are likely to touch during eliminates the possibility of a dentist or auxiliary dental care provider treatment. This eliminates the possibility of a transferring germs from a contamidentist or auxiliary dental care provider transferring nated surface to the patient. To save germs from a contaminated surface to the patient. time in preparing the treatment room for the next patient (and hopefully minimize their time in the waiting area), many practices recognized infection control experts. The organization choose to cover surfaces, such as light handles, tubing and offers an online collection of resources, publications, chair controls, with a plastic barrier film that keeps the FAQs, checklists and toolkits that help dental professionsurface underneath free of debris. Instead of disinfecting als deliver the Safest Dental Visit for their patients. Plus, these surfaces between patients, the dentist or dental team online and live courses help advance the level of knowlmember simply removes and discards the barrier and places edge and skill for every member of the dental team. For a new, clean barrier on the surface for the next patient. additional information, visit ISSUE 1 • 2019 : 35

Infection Control

First Impressions The look and feel of the reception area is important, but keeping it free of germs and infection is critical to the health of patients and staff. By Laura Thill

The dental reception area is the initial point of reference for patients, who expect a clean, welcoming environment that attests to the professionalism of the practice. Anything less may make them think twice about returning, according to Lean Keefer, RDH, BS, MSM, director of clinical services and education, Crosstex, A Cantel Medical Company. “We never get a second chance to make that first impression,” she points out. “The appearance of the reception area reflects the attitude and habits of the dentists and staff,” says Keefer. “It’s critical to make a positive, lasting impression. In addition, the reception area should be designed to optimize patients’ mood and well-being, as well as improve their perception and experience.” Patients are reported to comment more frequently on their experience in the reception area than on the dental team’s clinical skills, she adds. “Clinical care and staff/patient relationships are key to having patients return, but don’t underestimate the power of how the dental office presents itself to patients.” Achieving the ideal look and feel of the reception area is only half the battle. Upper respiratory and seasonal illnesses are easily spread, making it imperative for the dental staff to follow regular infection control protocols. “Upper 36

Efficiency In Group Practice : ISSUE 1 • 2019

respiratory and seasonal illnesses can be spread through direct contact with mucous membrane; cross-contamination with clinical contact surfaces; and droplet transmission, including sneezing and coughing, which spreads the pathogens by large particle droplets that carry microorganisms,” says Keefer. “People with flu can spread it to others up to about six feet away,” she continues. “Most experts think that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby, or possibly be inhaled into the lungs. Less often, a person might get flu by touching a surface or object that has flu virus on it, and then touching their own mouth, nose or eyes.” ( People often misread their seasonal illnesses, Keefer continues. For instance, a sick person can be contagious before his or her symptoms appear. “If you have a cold, you’re contagious for one or two days before your symptoms develop and for two weeks after you are first exposed to the virus,” she says. “With the flu, people are the most contagious in the first three to four days after symptoms begin. However, it is possible to infect others


Clean Water. Clear Choice.™

Using tablets for waterline compliance may come at a cost to your practice

The disadvantages of using tablets add up • $821/year for just one operatory*: Approximate cost for following tablet instructions for use (IFU)

DP365B Independent Water Bottle Cartridge For independent water bottles. Easily installed by dental staff onto existing pickup tube with included fitting.

• Shocking and monitoring: Required procedures included in ALL tablet IFUs - Necessary to maintain compliant CFU counts

• Tablets must be added at every water change and given the proper time to dissolve

With the DentaPure™ Cartridge, ensuring dental unit waterline safety has never been easier.

• Potential risk of staff daily exposure to chemicals

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• Service technician calls may increase due to a gradual buildup of tablet residue and undissolved tablets potentially blocking connections and narrow passageways. Tablet residue and undissolved tablets may also adversely affect expensive handpieces over time.

1 Year of compliant water†

• Staff time and expense to manage daily tablet use as well as shocking and monitoring procedures per IFUs

All claims based on use with potable water. * Includes cost for initial shock, daily tablets, shocking per IFU quarterly waterline testing and labor. † Or 240L of water, if usage records are kept. All product names are trademarks of Crosstex International, Inc., a Cantel Medical Company, its affiliates or related companies, unless otherwise noted. © 2019 Crosstex International, Inc. 1218 DLIT00586 Rev A

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Infection Control

a day before symptoms start. Children and those with weakened immune systems may pass the virus for longer than seven days.”

How clean is that surface?

Cold viruses have been shown to survive on surfaces for several days, while flu viruses are capable of being transferred to hands and causing an infection that can survive First lines of defense on hard surfaces for 24 hours. The reception area receives heavy traffic, from early The staphylococcus aureus bacteria that cause MRSA morning to evening. If left unattended, it inevitably will infections can survive for days to weeks on surfaces. become cluttered with waste and carry the potential for MRSA bacteria can live on surfaces for longer than some cross-contamination, notes Keefer, who recommends other bacteria and viruses because they survive better daily cleaning and maintenance, with emergency cleanups without moisture. Generally, MRSA bacteria survive for throughout the day as needed. “The staff shouldn’t ignore longer on hard surfaces than on soft surfaces. Germs gendetails that can differentiate the practice,” she explains. erally remain active longer on stainless steel, plastic and “They should take 10 minutes to sit down and carefully similar hard surfaces than on fabric and other soft surview the reception area through the eyes of a patient. faces. Other factors, such as the amount of virus depos“Boxes of facial tissues and pump bottles of alcoited on a surface and the temperature and humidity of the hol-based hand rub should be appropriately placed for environment, can also affect how long cold and flu germs patient use in the reception area,” Keefer continues. stay active outside the body. The dental staff should follow surface disinfection protocol for “ Durable, washable surfaces – including both housekeeping surfaces using the appropriate chemical/cleaner and healthcare grade and those manufactured for process with dwell time. That said, commercial use – are easier to clean. Clean first, then they should be mindful, as strong use an appropriate level of sanitizer or disinfectant as cleaning solutions used to kill germs can cause respiratory problems. indicated, based on the surface being treated.” They should wear appropriate per– Lean Keefer, RDH, BS, MSM, director of clinical services sonal protective equipment (PPE) and education, Crosstex, A Cantel Medical Company during cleaning and maintenance, including a Level 1 ASTM face “Wastebaskets with lids should be positioned for easy mask, safety eye protection and heavy-duty utility gloves, access to avoid used tissues being left on tabletops or says Keefer. “PPE must be donned/doffed appropriately, hidden under chairs.” It’s also important to account for and hand hygiene should be performed immediately after patient demographics when selecting and arranging furdoffing PPE.” niture, she points out. “Given that some patients value It’s important to take a consistent, organized their privacy and are concerned about other people’s approach, she says. “Cleaning from high to low, and back germs, it’s better to arrange small groupings of chairs than to front, helps avoid dust and debris falling back onto line them up along the perimeter of the room.” the surface,” she explains. “Durable, washable surfaces – including both healthcare grade and those manufactured Posting respiratory etiquette and hand hygiene signs in for commercial use – are easier to clean. Clean first, then the reception area can serve to remind patients to cover use an appropriate level of sanitizer or disinfectant as inditheir coughs and wash their hands, she says, noting that cated, based on the surface being treated. (The friction of posters may be downloaded from the following websites: cleaning removes most germs, leaving remaining germs to • be addressed by the sanitizer or disinfectant.) infectioncontrol/cover/ “Sanitizing reduces germs on inanimate surfaces to • levels considered safe by public health codes or regulaclean8.pdf tions,” says Keefer. “Disinfecting destroys or inactivates 38

Efficiency In Group Practice : ISSUE 1 • 2019

Is your steri-center up to SciCan SPEC s? ™

An often overlooked part of many practices is the sterilization area, the heart of every practice. If instruments do not efficiently flow into and out of it, the rest of the practice suffers. Your steri-center should improve Safety, ensure Predictable results, maximize Efficiency, and maintain Compliance.

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Infection Control

Televisions, monitors and cords should be wiped with a dry microfiber cloth approved for electronics and no-scratch surfaces. The entire surface of remote controls, keyboards and mouse pads should be wiped. It’s particularly important to address buttons, which are a source of cross contamination.

most germs on inanimate objects, with the exception of bacterial spores and prions. It is important to follow the manufacturer’s instructions for use and maintain the safety data sheet binder for any cleaning materials or products used in the office. Microfiber cloths and flat mop heads are recommended due to their ability to pick up and hold dirt, as well as efficiently absorb liquid, notes Keefer. “The absorbency of microfiber is up to seven times its own weight in liquid, which is great for cleaning spills or glass surfaces, without leaving streaks.” It can be helpful to keep color-coded, microfiber cloths on hand for each purpose, she adds. “Using machine washable microfiber cloths can help cut the cost of disposable cleaning products, such as paper towels. By folding the microfiber cloth into thirds lengthwise, and then again in half provides, multiple clean surfaces during cleaning and dusting. And, it’s better to spray a cleaning/disinfecting product directly onto the cloth as opposed to the surface to reduce aerosol and 40

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respiratory hazards. In addition, she recommends adhering to the following protocols: • Windows, doors, walls and mirrors. All floors, walls, surfaces, cabinets, drawers, and equipment must be capable of being quickly and easily cleaned and disinfected. Using a microfiber cloth, damp wipe vertical surfaces and ledges, paying particular attention to smudges and fingerprints; use a cleaning agent as needed. • High Touch Surfaces. This includes – but is not limited to – door handles, cabinet knobs, light switches, remote controls, phones and sink faucets, which should be cleaned and disinfected daily with an EPA-approved disinfectant. If high-touch surfaces become visibly dirty, they should be immediately cleaned and disinfected. • Furniture. Regular vacuuming of upholstered items can refresh the fabric and keep furniture looking good. The dental staff should spot clean any fabric and use appropriate solutions for vinyl and leather surfaces. They should dust light bulbs and replace burned-out bulbs. Using plug protectors in electrical outlets help keep younger patients’ fingers safe. • Tables and wood. All wood trim on furniture and tables should be dusted. A mixture of a cup of olive oil and a quarter-cup of white vinegar can nourish the wood and help it retain its shine. Plus, the vinegar is a natural germ killer. In addition, the furniture legs, the front of the reception desk and other surfaces should be scrubbed. • Interactive toys. Toys, games and play equipment can be easily wiped clean. It’s helpful to limit toys to those that are washable, with fewer parts and smooth/flat surfaces. Colorfast, plastic

toys can be disinfected using a solution of a ½ cup of bleach per gallon of water. Toys should be soaked for five minutes, then rinsed and air dried. • Electronic equipment. Televisions, monitors and cords should be wiped with a dry microfiber cloth approved for electronics and no-scratch surfaces. The entire surface of remote controls, keyboards and mouse pads should be wiped. It’s particularly important to address buttons, which are a source of cross contamination. Alternatively, single-use disposable surface barriers may be used to protect electronics. • Trash and Recycle Containers. Loose trash should be picked up throughout the day and properly disposed of. When checking the trash bin for emptying, staff should refrain from reaching into, or pushing on, the trash liner to compress the trash. Rather, they should leave the liner in container, close the top, and twist and tie a knot in the top of the bag. (When disposing of the trash bag, it should be carried away from one’s body.) All surfaces of the trash container should be wiped down with a surface disinfectant wipe and allowed to air dry before replacing it with a new liner. • Flooring. Carpets should be vacuumed daily using a HEPA filter, low decibel vacuum cleaner. They should be

spot cleaned as needed, and cleaned every three months. Hard flooring should be cleaned using a broom or dust mop, followed by flat-head mop for light cleaning. • Odors. Odors can be particularly offensive to patients and staff. A good ventilation system with charcoal filters can help minimize unpleasant odors. Cautionary use of disinfectant/deodorant sprays is recommended, as patients may be allergic or have respiratory concerns. Throughout the day, the dental staff should practice proper hand hygiene. Washing hands with soap and water is the best way to get rid of germs. If soap and water are not available, an alcohol-based hand sanitizer (minimum 60 percent) is recommended. The staff should offer respiratory prevention packets (i.e., a disposable surgical mask, facial tissues and cleansing wipes) to all symptomatic patients. And, they should attempt to isolate all patients with suspected illnesses. Loose items should be kept organized in containers, office policies should be saved in plastic sleeves in a three-ring binder, and magazines and pamphlets should be stored in clear plexiglas holders and wall mounts to keep them orderly. “While studies have shown low fomite contamination of the glossy pages, some offices are removing magazines from the reception area and asking patients to bring their own reading materials and children’s toys to reduce the risk of cross contamination,” says Keefer.

Infection prevention resources The CDC offers a number of resources, including its Summary of Infection Prevention Practices in Dental Settings: Basic Expectation for Safe Care (2016) and Respiratory Hygiene/ Cough Etiquette in Healthcare Settings, which are designed to limit the transmission of respiratory pathogens spread by droplet or airborne routes. The strategies primarily target patients and individuals accompanying patients to the dental setting, who might have undiagnosed transmissible respiratory infections; however, they apply to everyone – including dental healthcare personnel – with signs of illness, such as cough, congestion, runny nose and/or increased production of respiratory secretions. Additional information related to respiratory hygiene/cough etiquette can be found in the 2007 Guideline for Isolation Precautions (available at: pdf/isolation/Isolation2007. pdf ). Recommendations for preventing the spread of influenza are available at: professionals/infectioncontrol/.

ISSUE 1 • 2019 : 41

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Safe Water, Safe Patients

Growing attention to the hazards of contaminated dental unit water has led more dental clinicians to take the necessary steps to protect their patients. There are no shortcuts to obtaining compliant dental water. Without the right products and protocols, however, dental practices will not be able to meet the acceptable standard for water delivered to patients during non-surgical procedures. What’s more, even though compliance with water safety standards in the United States has not been required by law, that is changing. “A dental practice simply will not achieve compliance without effective, EPA-validated products used in accordance with the correct protocols,” says Jerod Mendolia, marketing assistant, Sterisil, Inc. “At Sterisil, our philosophy is embodied in the acronym, PPC: Products + protocols = compliance. We have applied this methodology with great success in various settings, from mid-sized five-chair clinics to Ivy League dental schools.” New technology is important, he adds. But unless clinicians are educated on the appropriate protocols and develop a conscientious attitude, “we are setting them up for failure.” 42

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A serious business Because dental water is used as an irrigant solution in conjunction with high-speed rotary handpieces, potentially contaminated aerosols and spatter can carry waterborne pathogens through the air, increasing the potential for infections. Unwanted health implications associated with contaminated dental unit coolants range from the exacerbation of existing asthma symptoms due to endotoxin exposure to complex bacterial infections, such as Legionnaires’ disease, according to the Organization for Safety and Asepsis Prevention (OSAP). In recent years, two high-profile cases have linked dental unit water to serious infections, notes Mendolia. The first incident occurred at Dentistry for Children in Jonesboro, Georgia. A second incident occurred at Children’s Dental Group in Anaheim, California. In both cases, Mycobacterium were isolated as the cause of infections in pediatric patients who received a pulpotomy procedure with contaminated dental unit water, he points out.

Although the Centers for Disease Control and Prevention (CDC) has recommended that water delivered to patients during non-surgical dental procedures meet Environmental Protection Agency (EPA) standards for drinking water (<500CFU), some question whether this is sufficient in a clinical environment. “In 1995, the American Dental Association challenged dental unit manufacturers to develop the equipment necessary to deliver effluent handpiece water with <200CFU,” says Mendolia. That standard has since been raised to the <500CFU/ml drinking water standard. “Currently, there are many products on the market validated to deliver levels of disinfection well below 200CFU. I don’t think it is unreasonable to expect dental professionals to meet this higher standard considering the number of products and protocols available with advertised effectiveness claims at ≤10CFU.”

The right solution For many dental professionals, the importance of delivering safe water during patient treatment is clear. Navigating their options, however, can sometimes be tricky. There are several methods available for treating water, notes Mendolia, and clinicians must stay informed in order to best serve their patients. There are advantages and disadvantages to each. There are many filter options capable of removing some level of microbial contaminants, but without the presence of a residual disinfectant, filtration alone is insufficient to consistently maintain and prevent microbial growth downstream from the filter, according to Mendolia. For best results, filtration should be paired with an ion exchange-based product for shock and residual disinfection. “Clinicians should steer clear of filtration methods that require water storage in a tank,” he says. “Unless the practice has something like a UV light after the tank, water storage can lead to incubation of existing bacteria in the tank to >500CFU. Most waterline treatment products will have some sort of disclaimer stating for use with potable water. So, contaminated storage tank water would be unsuitable for use with many chemical treatments based on this alone. “Since the introduction of the independent bottle reservoir, chemical treatments have become a viable and convenient method for reducing effluent dental water microbes,” he continues. “When dental clinicians follow the instructions for use (IFUs), they can expect good

results. However, when using municipal tap water, they must do so with caution. Municipal contaminants like chlorine and copper can interfere with the efficacy of some chemical treatments. The best regimens will always feature both shock and maintenance treatments that are compatible with one another. Whenever possible, clinicians should use distilled water in their bottle reservoirs for the best results.” In theory, in-office distillers are a viable solution, notes Mendolia. However, they are often associated with water test failures. “The machinery of distilling demands regular cleaning and disinfection to ensure the water purity and microbial viability,” he explains. “Once water has been heated into a gas and condensed back into liquid, it no doubt will be above room temperature. This increases the likelihood you are incubating bacteria as it’s – Jerod Mendolia, stored. Without a residual Sterisil, Inc. disinfectant or some sort of shock treatment prior to introduction to the chair, it’s unlikely the 500CFU drinking water standard will be met, and the practice risks violating the manufacturer’s labeling. “Don’t get me wrong,” he says. “Distilled water is much better than municipal tap water in just about every way. But physically distilling water is not the most effective method. Deionized water is essentially the same thing, and the process by which it is created does not increase the bacterial content. It is for this reason, all Sterisil systems employ this technology as the final purification step. Now you have a very pure base water to which a residual disinfectant can be introduced, with minimal interference from microbes or chemical contaminates.” Pre-sterilized water is clean enough for any dental procedure, says Mendolia. “However, once it is introduced into a dental chair, it is unlikely to meet the <500CFU standard,” he points out. “Unless the dentist

“A dental practice simply will not achieve compliance without effective, EPA-validated products used in accordance with the correct protocols.”

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Infection Control

intends to irrigate with single-use pipettes or purchase a very expensive sterile water generator, this will not be a viable option.” And, the cost of purchasing sterile water makes this an unaffordable option for many dental practices, he adds. Mendolia recommends that dental practices use their bottle reservoirs for their intended purpose. “The independent bottle reservoir was designed to isolate the dental unit from municipal tap water and provide a conduit through which antimicrobial treatments could be introduced,” he says. “Tap water is not suitable for the dental setting for many reasons, but particularly due to the infinite variability in water chemistry. If clinicians are using residual disinfectants to control microbes in a dental chair, these details matter. Distilled water will always save the dental practice a lot of headaches in the end, trust me.

retest per the waterline treatment manufacturer’s IFU. I personally recommend testing through a third-party lab that specializes in dental water microbes, like Agenics. They offer HPC counts and many other water chemistry metrics that help diagnose problems should they arise.”

Legal precedent Compliance with water safety standards in the United States has not been required by law. But, that’s quickly changing. “Water compliance may not have been the law in 2016, when 73 pediatric patients contracted Mycobacterium infections from contaminated dental water at Children’s Dental Group in Orange County, California,” says Mendolia. However, in 2019, it will become a law in California, he points out, noting that eventually much of the country will likely follow suit. “What I try to impress on people is that this issue isn’t going away,” he says. “Now that there are legal precedents associated with patient vs. clinicians, and manufacturers vs. clinicians, with regard to this topic, it will be difficult for dental clinicians to prove in court that they are not responsible for any infections related to dental water in their practice, even if they weren’t legally required to take action.” That said, for some dental professionals, cost will always be an obstacle. “We must focus on the relative cost per liter differences among the various products, relative to their overall need for water,” says Mendolia. “If a large practice intends to confront this problem head on, it would serve them well to go with the option that has the lowest cost per liter. That’s not always the lowest initial cost, but the purchase will pay for itself with time. Sometimes dental practices just want to get their toes wet, so to speak. “Low cost options like Citrisil tablets are a good place to start, with the same great treatment you get from the higher end products,” he says. But, they’re not as convenient as a long-term solution. “The low-cost options in this category always leave something to be desired when it comes to efficiency and cost per liter.” As more practitioners are on board with the need for waterline treatment, they are looking for solutions that provide enhanced efficiency and require less staff involvement, notes Mendolia. “We are here to help,” he adds.

“ The initial test validates the product and protocol’s efficacy, and subsequent tests validate the protocol execution throughout the product’s lifespan (assuming the product did not expire prematurely). If both tests pass, the practice can begin testing every six months.” “Dental practices should always consult with their dental unit manufacturers and their waterline treatment providers about water testing,” Mendolia continues. “Minimum standards for water testing should be followed whenever possible, even though they are recommendations rather than requirements. If the dental practice’s protocols are in line with these standards, it is off to great start.” A passing water test verifies the absence of bacteria and validates the dental practice’s disinfection efforts, he points out. “According to OSAP, dental practices should be testing within 30 days of introducing a new product or new protocols, and then every 30 days thereafter,” he says. “The initial test validates the product and protocol’s efficacy, and subsequent tests validate the protocol execution throughout the product’s lifespan (assuming the product did not expire prematurely). If both tests pass, the practice can begin testing every six months. If there is a test failure, the clinician should shock immediately and 44

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Biotec Custom Steri-Centers: Sterility assurance for any size practice By Howard Sorenson, vice president of sales, Porter Royal Sales Group

Some points to consider when designing a steri-center include: • Is the current steri-center in need of a face lift? • How many procedures does the dental practice perform each day? • What is the current protocol for procedure setups? (Using instrument cassettes not only saves time, but will reduce the amount of space required.) • How does the practice currently process its handpieces? • Do the material setup tubs match the practice’s instrument setups? • How does the practice dispose of biohazardous materials? It’s important to determine where to bring contaminated instruments into the steri-center, as well as where to leave sterile, ready-for-use instruments. In addition, it’s important to measure the space and identify electrical outlets, as well as

Designed by Biotech, Inc.

Sterility assurance depends on good design of the space designated for instrument processing. First and foremost, steri-centers must be designed to comply with OSHA and CDC standards. In addition, a well-designed steri-center facilitates organization, efficient processing of dental instruments and the quick turnover of dental instrument setups. In many cases, traditional straight-line steri-centers work very well. But older, U-shaped centers, which do double duty as supply storage areas, do not! That said, the use of modular dental cabinetry and some custom-built modules can make any size or shape of space become a functional efficient steri-center. And with the growth of larger group practices and DSO-type facilities, many practices require a mega-sized steri-center to accommodate the flow of staff and trays. A well-designed steri-center should incorporate the systemized processing of instruments, the use of cassettes, and protocols for color coding of instruments, handling biohazardous materials, cleaning instruments and storing sterile instrument setups.

where plumbing and lighting will go. (If necessary, is it possible to move any of these utilities?)

The large group practice The large practice presents a unique set of challenges for a private practitioner. Given the magnitude of instruments that require processing, and the movement of staff entering and exiting the sterilization center, the space must be well designed to maximize efficiency and guarantee efficacy. In one particular case, for instance, Biotech, Inc. created a steri-center with two entries: a pass-through from the hallway outside the space at one end for receiving contaminated trays, and a pass-through at the other end of the steri-center for the sterile trays to be picked up for use with the next patients. This design greatly minimized the staff traffic in and out of the work space. Another possible bottleneck is having a single sink in these large practice steri-centers. Having a double sink with two faucets, multiple Hydrim type washers, and ultrasonic cleaners need to be considered to prevent one area of the instrument processing from slowing down the recycle time. Sufficiently analyzing the work flow and procedures completed at the practice, as well as consulting with the staff that does the instrument processing, help ensure the final steri-center design is best suited to each particular practice. ISSUE 1 • 2019 : 45

Infection Control

Medical Waste Management

By Katherine Schrubbe, RDH, BS, M.Ed, PhD Dr. Katherine Schrubbe, RDH, BS, M.Ed, PhD, is an independent compliance consultant with expertise in OSHA, dental infection control, quality assurance and risk management. She is an invited speaker for continuing education and training programs for local and national dental organizations, schools of dentistry and private dental groups. She has held positions in corporate as well as academic dentistry and continues to contribute to the scientific literature. Dr. Schrubbe can be reached at kathy@


Rules, regulations and standards of care abound in the dental profession. In order for the dental team to comply, all team members must have a clear understanding of the requirements and mandates. In short, it can be overwhelming. While the primary goal of the dental practice is to provide the highest quality patient care and the best patient experience – all while ensuring patient and staff safety – team members must be efficient, well-organized and competent in the completion of the tasks and duties related to the requirements and mandates. This creates a culture of standardization and calibration. The instrument processing protocols, how to prepare and turn over operatories, and hand hygiene are all examples of tasks that should happen like clockwork. What to dispose of – the where and how of waste management – is also one of those tasks. Dental team members who are unsure of the appropriate steps to take may be making costly errors that hurt the dental practice.

Managing medical waste in the dental setting Let’s review the types of medical waste produced in the dental setting and the protocols for management and disposal. It should be noted that the Centers for Disease Control and Prevention (CDC) states that dental healthcare facilities should dispose of medical waste regularly to avoid accumulation, and any facility generating regulated medical waste should have a plan for its management that complies with federal, state and local regulations to ensure health and environmental safety. Also, dental team members handling waste should be trained in appropriate methods and informed of the potential hazards.1 Having a clear plan, as well as understanding the risks involved, will streamline processes and productivity related to medical waste disposal. Many times, team members are confused with the terms defining the various types of waste. There are basically two types

Efficiency In Group Practice : ISSUE 1 • 2019

of waste generated in dental practices: regulated and nonregulated medical waste. General medical waste is defined as any solid waste that is generated in the diagnosis, treatment or immunization of human beings or animals in research pertaining thereto, or the production or testing of biologicals. (The term excludes hazardous and household waste.). Only a small percentage of medical waste is infectious and needs to be regulated.2,3,4 Infectious waste, which is regulated, is a very small subset of medical waste (about 3 percent) that has proven to be capable of transmitting an infectious disease.3 The Bloodborne Pathogens standard uses the term regulated waste to refer to the following categories of waste, which require special handling: • Liquid or semi-liquid blood or other potentially infectious material (OPIM). • Items contaminated with blood or OPIM, which would release these substances in a liquid or semi-liquid state if compressed. • Items that are caked with dried blood or OPIM and are capable of releasing these materials during handling. • Contaminated sharps. • Pathological and microbiological wastes containing blood or OPIM.5 Most of the regulated waste in dental offices consists of contaminated sharps and extracted teeth. However, other examples of regulated medical waste categories in dentistry, such as those listed above, include liquid blood or saliva; two-by-twos or cotton rolls saturated/caked with blood or saliva; used needles, scalpel blades, ortho wires, broken sharps instruments, burs, biopsy specimens and excised tissue.3 The practice management team must be certain that dental team members are trained and have a clear understanding of how to separate regulated waste from nonregulated waste to ensure a purposeful segregation. The practice incurs a cost from regulated waste because it must be picked up and transported off-site by qualified waste hauler vendors; therefore, only items that are considered infectious should be placed in regulated waste receptacles (commonly known as the red biohazard bags or red biohazard sharps containers). Non-sharp regulated waste items, such as those listed above, must be disposed of in red biohazard bags. Contaminated

sharps, however, must be disposed of in red biohazard sharps containers. OSHA points out that contaminated sharps shall be discarded immediately or as soon as feasible in containers that are closable, puncture resistant, leakproof on the sides and bottom and labeled or color-coded. OSHA also states that, during use, containers for contaminated sharps shall be easily accessible to personnel and located as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found, maintained upright throughout use, replaced routinely and not allowed to overfill. Lastly, when moving containers of contaminated sharps from the area of use, OSHA states that containers shall be closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport or shipping, and placed in a secondary container if leakage is possible. The second container shall be closable; constructed to contain all contents and prevent leakage during handling, storage, transport or shipping; and labeled or color-coded according to this standard. Reusable containers shall not be opened, emptied or cleaned manually or in any other manner that would expose employees to the risk of percutaneous injury.6 The CDC recommends that sharps containers be located as close as possible to the work area.1 Accordingly, every operatory should have a red biohazard sharps container, which should be stored in a place inaccessible to small children who could mistake a red container for a toy or surprise box. Once procedures are complete, staff members should dispose of any disposable sharps in the operatory sharps containers. All other used items from patient care that have not been disposed of in red biohazard bags or sharps

It should be noted that the dental practice remains responsible for the regulated waste it generates until it is destroyed or rendered nonhazardous.

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Infection Control

containers may be safely thrown out in the regular trash. Items such as barriers, gloves, masks, bibs, lightly soiled gauze and cotton rolls are not considered infectious or dangerous to the environment.3 Medical waste is primarily regulated by state environmental and health departments. The Environmental Protection Agency (EPA) has not had the authority to oversee the handling of medical waste since the Medical Waste Tracking Act (MWTA) of 1988 expired in 1991. It is important for the dental team to contact their state environmental program before they dispose of medical waste. They should contact their state environmental


protection agency at, as well as their state health agency, for more information regarding their state’s regulations on medical waste.2 It should be noted that the dental practice remains responsible for the regulated waste it generates until it is destroyed or rendered non-hazardous. This concept, which is called cradle-to-grave liability, means that even after waste leaves the practice, any cleanup for any damage it may cause is the responsibility of the generator (the practice); so, the practice should carefully select a licensed waste hauler.3,4 Recordkeeping for the disposal of waste must meet state regulations. The most critical record is the waste manifest – a tracking document that comprises the name of the generator (dental practice), transporter, disposer and the waste itself. It also may include the description and quantity of waste, date, type of container and the type of final disposal.4 All manifest records must be kept for three years.4 The management of medical waste in a dental practice is a critical component of compliance to federal, state and local agency standards. Regardless of the practice size, all dental team members must be aware of what to dispose of, and how and where to dispose of it. Otherwise they risk taking a haphazard approach to the disposal of hazardous materials, causing potential risk to patients and staff, as well as the environment.

1. Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings --- 2003. MMWR 2003;52(No. RR-17). Available at: Accessed November 18, 2018. 2. U.S. Environmental Protection Agency. Medical Waste. Available at medical%20waste. Accessed November 18, 2018. 3. Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team. 5th ed. St. Louis: Mosby Elsevier; 2013;192-196. 4. OSAP Interact Training System Workbook. OSHA and CDC Guidelines; Combining Safety with Infection Control and Prevention. 5th Edition; 2017. 5. U.S. Department of Labor. Occupational Safety and Health Administration. Bloodborne Pathogens Standard; 1910:1030. Most frequently asked questions concerning the bloodborne pathogens standard. Available at Accessed November 18, 2018. 6. U.S. Department of Labor. Occupational Safety and Health Administration. Bloodborne Pathogens Standard; 1910:1030. Available at https:// Accessed November 18, 2018.


Efficiency In Group Practice : ISSUE 1 • 2019

Enhanced Hygiene

Create a Successful Hygiene Day Five tips hygienists need to know and do By Tama Martello, RDH, Practice Development Coach for Enhanced Hygiene

To create a smooth visit for patients, and a more productive hygiene day for group practices, follow and incorporate the below tips into the daily routine. You’ll be guaranteed smiles and grins all month long.

Tip No. 1: Be prepared for a morning huddle In the morning huddle, you don’t want to discuss what treatments are already scheduled. In the morning Instead, focus on the opportunities. huddle, you don’t What opportunities might exist want to discuss that aren’t scheduled? Also, when what treatments chart prepping, don’t just look for are already the basics like who needs an exam, scheduled. Instead, focus on but truly look beyond the exam at the opportunities. the patient’s wants and needs prior What to them sitting in the chair.

Tip No. 2: Explore the opportunities

opportunities might exist that aren’t scheduled?

Doing your research and looking further into the patient’s opportunities is key to a successful patient visit. Ask yourself the following questions: • Is the patient due for a FMX? •D o they have a history of periodontal disease? If so, regardless of what their insurance covers, a FMX should be taken every 36 months. • Are they moderate/high risk caries? • Has orthodontia been discussed with this patient to correctly align teeth? • Is this patient a clencher or a grinder that might need a nightguard? • Does your patient have existing outstanding treatment?

Top No. 3: Check health history, insurance coverage and patient status Checking the health history, insurance coverage and patient status is all part of your due diligence prior to seeing your patient. Ensure you check the health history for medications that may cause xerostomia and be prepared to talk with the patient about possible solutions. 50

Efficiency In Group Practice : ISSUE 1 • 2019

You’ll also want to check the patient’s insurance verification of co-pay for fluoride and sealants and be prepared to discuss why your patient might need these treatments. If scaling and root planning (SCRP) was performed previously and they might need it again, check to see when the insurance was last billed. Lastly, ensure you know if the patient is new to the practice or if the patient has been seeing one specific doctor. If a different doctor is scheduled, make sure you introduce them so both the doctor and patient are at ease.

Tip No. 4: Have discussions with your patient When you have your patient in the chair, this is your time to educate and explain what they might need and want during their visit and afterwards. Discuss any outstanding treatment that is documented and take a new intra-oral photo of that area. This way, you’ll have updated information for the doctor to discuss next steps and a possible same-day treatment plan with the doctor. If the patient is a periodontal maintenance patient and there is still pocketing with bleeding on probing (BOP), explain to the patient they might need further procedures such as SCRP again or arestin/laser treatment or possibly they should be referred out to a periodontist. Maybe your patient is a prophylaxis patient and has had consistent 4 mm pockets with BOP, discuss gingivitis therapy (D4346) and discuss shortening their recall. Of course the doctor will give the final course of action, but it’s good to discuss and explain options prior to the exam. This way it shortens exam time for the doctor.

Tip No. 5: Always keep your room stocked You don’t want to have to get up and leave the room for anesthetic, arestin, desensitizer, take home fluoride, etc. Making sure your room is stocked saves time and hassle. Following and incorporating these five tips may add a little bit of time and effort on your part but in the end, you’ll be glad you did it. Owning your schedule will ensure your hygiene days are successful and productive! For a chart prepping/morning huddle list to use in your practice, visit


Be the Leader They Want By Lisa Earle McLeod

A recent Forbes article revealed that 65 percent of people would rather have a different boss than a raise. Take that in for a moment: People would trade money for a better boss

Words of leadership wisdom When I was 25 years old, my father shared something with me that forever altered my perspective on leadership. I had just been promoted to my first manager position at Procter & Gamble. I called my father to give him the good news. “Congratulations,” he said, “You’ve just become the second most important person in the life of your employees.” “What do you mean?” I asked.

He explained, “Next to your spouse, your boss has the power to make your life wonderful or miserable.” At the time, his comment petrified me. At the ripe old age of 25, half my team was twice my age. I was scared to death because I knew my father was right.

Your leadership makes an impact Think about your bosses and the impact they’ve had on you. Your boss is a presence at the family dinner table, in conversations with your friends, with your parents. When I was a kid we talked about my Dad’s boss, Mr. Keck, almost every night. I knew when he was in a good mood or bad mood. I knew about his family. My mother was a schoolteacher. I knew about her principals – the good and the bad. I even knew about the time one of them had a breakdown when she was getting divorced. If you’re the boss, you’re a looming presence in the lives of your people, whether you like it or not. You have the power to create happiness, or misery. 52

Efficiency In Group Practice : ISSUE 1 • 2019

How to be a great leader After working with thousands of employees and leaders, I can tell you, the one mantra that will make you a better boss: Be all in. People want a boss who cares and who isn’t shy about showing it. Great leaders don’t shy away from emotion. They love their job, they love their customers, and they love their team. And they’re not afraid to let everyone know it. For them, business is personal. They don’t shy away from difficult conversations. They care enough to address the tough stuff, head on. They give direct feedback. Great leaders are attuned to the emotional undercurrents of their organization. They’re not perfect, but their team knows their passion comes from their belief in a cause bigger than themselves. As a leader, you’re the one who tells your people whether this is just a job, or if their work actually matters. For great leaders, work is more than just a transaction – it’s a chance to make a difference in the lives of other people. They build a tribe of True Believers because they’re all in.

What will your team say about you? I wrote Leading with Noble Purpose to help leaders emotionally engage with their people. It’s a call for today’s managers to become the kind of leaders a team wants to follow. As the late Maya Angelou said, “I’ve learned that people will forget what you said. People will forget what you did. But people will never forget the way you made them feel.” Your team is going to talk about you at their dinner tables whether you like it or not. You can be the leader whose team experienced their work as just a grind. Or you can be the leader whose people say, “She really cares.” The choice is yours. What steps do you have to take to be the kind of leader your people want?

CHAMPIONS for CHANGE Gala Benefitting Oral Health America for 29 years

Wednesday, February 20, 2019 5:30 p.m.-9:00 p.m. J O I N U S AT S O L D I E R FI EL D’ S U NI TED C L U B 1410 Museum Campus Drive, Gate 14, Chicago, IL 60605 Together we honor Dr. Larry Coffee, founder of the Dental Lifeline Network, with our Champion for Change Award, and we recognize Ivoclar Vivadent as a Million Dollar Donor. $375 per ticket or $3,750 per table Contact Liz Kelly at 312-836-9900 or 180 N. Michigan Ave., Suite 1150, Chicago, IL 60601 • 312-836-9900 • OralHealthAmerica •

Smile4Health •


INDUSTRY NEWS DecisionOne Dental named one of the Top Workplaces in Illinois by The Chicago Tribune DecisionOne Dental has been named as one of the Top Workplaces in Illinois by The Chicago Tribune as evaluated by Energage, a national leader in workplace culture development and employee performance research, according to a release. The company was the highest ranked dental business in Illinois regardless of size and No. 16 of all mid-sized companies with 250-999 employees. Energage has surveyed over 50,000 businesses nationwide to develop its criteria to identify companies with excellent workplace cultures. The Top Workplace designation was based on an independent survey of DecisionOne Dental employees by Energage. DecisionOne Dental is one of the fastest growing dental service organizations in Illinois with currently 274 team members at 26 dentist offices across the Chicagoland area and a support center based in Schaumburg. “We’re really honored and humbled by this award,” said Dr. AJ Acierno, CEO and co-founder of DecisionOne Dental. “We created a company with a purpose to put people – patients and team members – first and that has drawn such an array of talented and dedicated people to work with us, people who want to be a part of our mission. For all of us this is so much more than just a job – we are literally changing the way dentistry is done to improve lives.”

Burkhart Dental hires John J. Klavon as Special Markets Director Burkhart Dental Supply announced the hiring of John J. Klavon as its Director of Special Markets. Klavon is a seasoned dental professional and proven leader with extensive expertise establishing and managing special (strategic) markets departments. In this new position, Klavon will assist John J. Klavon and support Burkhart Dental Supply’s associates and special market customers in navigating the ever-changing environment of the dental industry. Klavon has 26 years of experience in the dental industry. He brings expertise in strategic account management, strategic vision and business planning, customer interaction, and 54

Efficiency In Group Practice : ISSUE 1 • 2019

sales management. Prior to joining Burkhart, he was Field Director Manager, Strategic Markets, for Benco Dental. Klavon is a graduate of Michigan State University with a degree in finance.

Heartland Dental reaches 900th supported office milestone Heartland Dental (Effingham, IL) announced that it recently crossed the milestone of 900 supported offices. Heartland Dental reached this milestone this year by continually supporting the opening of brand new “De Novo” offices and affiliating with existing dental offices throughout the country. In 2018, the company increased its footprint to 37 states. “Starting out with a handful of supported offices in a few states to now supporting 900 offices across the country, it’s been amazing to see how our company has grown in just a few decades,” said Patrick Bauer, President and Chief Executive Officer at Heartland Dental. “This is only the beginning. We will continue to make strides in our mission of becoming THE leader in dentistry, and look forward to celebrating many more of these milestones in the future.”

Smile Brands opens 23rd Washington office Smile Brands (Irvine, CA) opened an affiliated Bright Now! Dental office in Kennewick, Washington. The new clinic is Smile Brands’ 23rd practice in Washington. It is also the first Bright Now! Dental to open in Kennewick. Robert Stockton, DDS, leads the new practice. He and his team offer orthodontics, Invisalign, oral surgery, periodontics and endodontics.

Aspen Dental launches national marketing campaign Aspen Dental (Syracuse, NY) launched a new national marketing campaign. This is the first time the company has run a fully integrated campaign featuring national and local TV advertising, radio, paid search, and social media and more. Developed in partnership with HEAT and Deloitte, the “Yes Campaign” features “the real stories of nine patients of Aspen Dental practices opening up about the barriers they faced in accessing dental care and how Aspen Dental practices helped them get back on to the road to good oral health – and changed their lives in the process.”





ALL PATIENTS A week in the life of a dental professional adds up quickly.

1,440 teeth. 45 smiles. 23 caries. Class II

Class V

OMNICHROMA eliminates the need for excess incidental shades and reduces the chance of unused composite expiring on the shelf. Innovated to color-match like you’ve never seen before, our unique dental composite is the first formula to match every smile from A1 to D4 with just one shade of composite, saving doctors time and money.

Every shade. One choice.

Case images courtesy of Dr. James Chae, Diamond Bar, CA *Limit one sample kit per doctor. While supplies last. Offer valid until 1/31/19. Samples will ship starting 2/1/19. Offer valid in US and Canada only. For evaluation purposes only. Participating doctors or dentists are obligated to properly report and reflect any bonus product, rewards, rebates, discounts or other benefit they receive on their submissions to Medicare, Medicaid, state or federally funded healthcare program and/or private insurance.

Call us at +1 (877) 378-3548

The New RMgI Restorative BEFORE AND AFTER pACkINg …

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LIghT-CuRED RESIN MODIFIED gLASS IONOMER RESTORATIVE • Composite-like esthetics and handling

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• Light-curing for fast finish and flexible working time • Immediately packable after application • Does not stick to the instrument, easy to shape • Excellent translucency for better esthetic results • High fluoride release minimizes secondary caries • Highly radiopaque • Fits virtually all GIC applicators • No dentin conditioner or adhesive required

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DENTAPEN by Septodont

the PERFECT MATCH for your practice

EFFORTLESS INJECTION That matches your preferences


Ergonomic and light (40g/1.4oz)

Focus your attention on the injection

Compatible with the needle of your choice

No cord minimizes pressure on hand and needle

Standard syringe grip or Nerve block finger grip

No console space saving No foot activation focus attention on the injection




Shown actual size.


A MORE COMFORTABLE INJECTION Improves your patients’ satisfaction with less fear of injection Constant flow 2 modes

3 speeds

Small and modern less fear of injection


Septodont has always been at the forefront of dentistry, providing you with a wide range of products and services to help you administer a painfree experience.


Septodont continues to innovate with the Dentapen the perfect match for your practice.


1x Dentapen Body


2x Finger Grips

Accessories #01N6010: Refill Finger Grips Syringe Style (5 per box) #01N6020: Refill Finger Grips Pen Style (5 per box) #01N6030: Refill Cartridge Holder (5 per box) #01N6040: Refill Battery (10 per box) #01N6050: Refill Protective Sleeves (250 per box)

7x Cartridge Holders

25 x Protective Sleeves

All accessories are available separately. Finger grips and cartridge holders must be sterilized before use.

DENTAPEN Beyond injection: Dentapen, the new generation of powered injector for Dental Anesthesia Matches your patients’ preferences: constant flow to reduce pain, non-threatening look Matches your needs: comfort and reproducibility of your injections all-day-long Matches your habits: no training, both syringe and pen-like handling, compatible with any needle

#01N6000: Dentapen Kit



of dentists tested received a palatal injection, and preferred the electronic syringe over the manual one

Interested in ordering? Visit






ALL PATIENTS A week in the life of a dental professional adds up quickly.

1,440 teeth. 45 smiles. 23 caries. Class II

Omnichroma simplifies each day. Innovated to color-match like you’ve never seen before, our unique dental composite is the first formula to match every smile from A1 to D4 with just one shade of composite. Every shade. One choice.

Class V Case images courtesy of Dr. James Chae, Diamond Bar, CA *Limit one sample kit per doctor. While supplies last. Offer valid until 4/30/19. Please allow 2-4 weeks for delivery of complimentary goods. Offer valid in US and Canada only. For evaluation purposes only. Participating doctors or dentists are obligated to properly report and reflect any bonus product, rewards, rebates, discounts or other benefit they receive on their submissions to Medicare, Medicaid, state or federally funded healthcare program and/or private insurance.

Call us at +1 (877) 378-3548

The culmination of 35 years of research and development, Tokuyama Dental is proud to present OMNICHROMA, the world’s first dental composite that matches every tooth with a single composite shade. Color and Composites All smiles have something in common, and that is the colors that make up human teeth shades. From A1 to D4, all shades of teeth express a narrow range of red-to-yellow color. White








Tooth color space












Lightness Hue

Greyish Shades Color Saturation





Reddish-Grey Darker

To match every smile, most composite brands require multiple shades. That’s because most composites today depend on the color of red and yellow dyes added to the resin material to emulate tooth shades. This means that dentists must keep a large inventory of different composites to accommodate a variety of patients.

OMNICHROMA Changes Everything OMNICHROMA is the first universal composite that offers one shade to match all patients. The red-to-yellow structural color generated by OMNICHROMA combines with the reflected color of the surrounding tooth and creates the perfect match for almost every patient.

Before Light Curing










After Light Curing

Just One Shade for Every Patient • No more shade selecting needed • No more excess product for incidental shades • No more expired composite








I N S ID E TH E T EC H NO LO GY Structural Color Structural color occurs when different wavelengths of light are amplified or weakened by the structure of a material itself, expressing colors other than what the material may actually be. From morpho butterflies to peacocks, some of the rarest and most beautiful colors in nature are the result of structural color.

Smart Chromatic Technology Through the utilization of Tokuyama’s spherical fillers and Smart Chromatic Technology, OMNICHROMA is the first use of structural color in composite dentistry. OMNICHROMA’s structural color mechanism is made possible by the precise shape and size of the filler within the composite. The 260nm identical spherical fillers of OMNICHROMA are the perfect size and shape to produce the effects of structural color to match the surrounding tooth color.

SEM Image of OMNICHROMA at 5,000x Magnification

Herculite™ Ultra

SEM Image of OMNICHROMA at 20,000x Magnification

Filtek™ Supreme Ultra

Tetric EvoCeram®



A1 Tooth

A4 Tooth

Excellent color match

Excellent color match

A1 teeth restored using OMNICHROMA

A4 teeth restored using OMNICHROMA

TPH Spectra® ST

OMNICHROMA Fillers generate red-toyellow structural color as ambient light passes through the composite, without the need of added pigments and dyes. The red-to-yellow color combines with the reflected color of the patient’s surrounding dentition, creating the perfect match from A1 to D4 and beyond.

F EAT URE S & BEN EFI TS • Unprecedented shade-matching ability and esthetics • Exceptional handling, polishability, and strength • Reduction of inventory of necessary composite shades • Reduction of expired composite • Minimized chair time and reliance on shade-matching procedures






Product Number: 10116

Product Number: 10126

Product Number: 10117

Product Number: 10127

Order OMNICHROMA Today Call +1 (877) 378-3548 or visit TOKUYAMA-US.COM

Tokuyama Dental America Inc.

740 Garden View Court, Suite 200, Encinitas, California 92024 Call: +1 (877) 378-3548 | Fax: +1 (760) 942-7212

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OMNICHROMA is a trademark of Tokuyama Dental. All rights reserved. All other trademarks and registered trademarks are not trademarks of Tokuyama Dental.