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For Dental Professionals June, 2010 A partnered publication withSales Dental Sales Pro •

For Dental Sales Professionals

April 2018

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April 2018

Publisher’s Letter American-made

Evacuation Line Maintenance Waterline Compliance

Waterline disinfection helps ensure a safe patient visit.

Safe dental water… …should be a priority at every practice.

A World of Change

In seven short years, Burkhart equipment specialist Louis Ullrich has moved cross-country, filled two positions and helped his dental customers navigate continuous advances in technology.


The Changing Face of Endodontics

A Look at OSHA

The Occupational Safety and Health Administration (OSHA) plays an important role in the dental industry.

New technology helps endodontists address complex treatments.


OSAP: 2018 OSAP Dental Infection Control Boot Camp™

Record breaking attendance reveals excitement for dental safety.

Measuring Up

Despite a rise in patient visits, dental services account for a small percentage of healthcare spending.


Technology News

Some cook or read to relax. Jorge Rodriguez takes refuge in leatherwork.



First Impressions

The Art – and Science – of Leatherwork

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American-made Talks of protectionism and international trade

wars have made following the financial markets a rollercoaster ride of epic proportions this spring. President Trump recently signed an executive memorandum that would add or raise tariffs on Chinese imports. In response, China drew up their own list of products they might target and levy tariffs on. We’ll have to wait and see how this tariff war plays out.

Every couple of years, First Impressions focuses on American-made dental products. This year it is more important than ever to find out from dental manufacturers how their American-made products are being received in the market. In this issue we talk to two equipment manufacturers about their American-made products and why they continue to manufacturer here in the United States. According to both Engle Dental Systems and Midmark Corporation, manufacturing in the U.S. gives these companies the unique ability for customers to tour the manufacturing facilities, watch the process, and even get a chance to meet the teammates who will make their specific products. Stephanie Woeste, director of dental marketing at Midmark, also points out that not only is the manufacturing U.S. based, but Midmark’s always-there-for-you support is too. Cheryl Buck, national sales manager of Engle Dental Systems, references that customers have shifted from a price-based purchasing mindset to a value-based one. Even if dental products which are manufactured in the United States cost more, generally speaking, customers are willing to pay a certain percentage more for these products. It is not only dental equipment manufacturers that are thriving while making their products in the United States; one infection prevention manufacturer has succeeded in keeping their manufacturing close to home. Crosstex, a division of Cantel, manufacturers 95 percent of their products in six facilities across the United States. In a highly competitive space, Crosstex found that manufacturing in the states gives the company the ability to closely monitor operations and continually improve product quality and worker conditions. Leeann Keefer, RDH, MSM, director, corporate education & professional relations, talks about the sense of pride the company has producing high-quality, American-made products. Rounding out our Stars and Stripes issue is one of our readers’ [and my] favorite columns. This issue’s Rep Corner features Jorge Rodriguez, a Benco Dental territory representative. Jorge joined the Army and spent time at a combat hospital servicing bio-medical and dental equipment. He also completed two tours of duty in Iraq. It was from the skills he developed at the hospital servicing equipment that Jorge was able to land his first job as a field service dental equipment specialist. In each Rep Corner we focus on the uniqueness of the reps in our industry, and Jorge Rodriguez does not disappoint. Prior to his time in the military, Jorge learned the art of leather braiding. He has developed and fine-tuned his leather making skills over time. Make sure you read Jorge’s Rep Corner and take a look at his leather creations. Happy Spring,

Bill Neumann


April 2018

First Impressions

Editorial Staff Editor Laura Thill lthill@ Managing Editor Graham Garrison ggarrison@ Founder Brian Taylor btaylor@ Publisher Bill Neumann wneumann@ Senior Director of Business Development Diana Craig dcraig@

Director of Business Development Jamie Falasz, RDH jfalasz@ Art Director Brent Cashman bcashman@ Circulation Wai Bun Cheung wcheung@ Weekly Drill Editor Alan Cherry acherry@

First Impressions is published bi-monthly by Share Moving Media 1735 N. Brown Rd. Ste. 140 • Lawrenceville, GA 30043-8153 Phone: 770/263-5257 • Fax: 770/236-8023 First Impressions (ISSN 1548-4165) is published bi-monthly by Share Moving Media., 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2018 by Share Moving Media. All rights reserved. Subscriptions: $48 per year. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Share Moving Media., 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors.

First Impressions editorial advisory board Shannon Bruil, Burkhart Dental Frank Cohen, Safco Steve Desautel, Dental Health Products Inc. Nicole Fox, Patterson Dental Suzanne Kump, Patterson Dental Dawn Metcalf, Midway Dental Supply Lori Paulson, NDC Patrick Ryan, Benco Dental Co. Scott Smith, Benco Dental Co. Tim Sullivan, Henry Schein Dental

Clinical board Brent Agran, DDS, Northbrook, Ill. Clayton Davis, DMD, Duluth, Ga. Sheri Doniger, DDS, Lincolnwood, Ill. Nicholas Hein, DDS, Billings, Mo. Roshan Parikh, DDS, Olympia Fields, Ill Tony Stefanou, DMD, Dental Sales Academy

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Louis Ullrich and Arne Valdez

A World of Change In seven short years, Burkhart equipment specialist Louis Ullrich has moved cross-country, filled two positions and helped his dental customers navigate continuous advances in technology.


April 2018

First Impressions

Trading his Southeastern roots for a new life in Anchorage, Alaska, did not come naturally for Louis Ullrich. His first winters in particular were a huge transition. “My friends thought I was crazy!” he recalls. Nevertheless, the Burkhart equipment specialist was determined to make the move, and today he can honestly say, “Alaska is a blast” for those who can handle the weather. In part, it was serendipity that landed Ullrich his first job out of college with Burkhart Dental’s Anchorage branch. As an undergrad at Winthrop University (Rock Hill, S.C.), he spent his summers with a host family in Alaska, where he played

college baseball. As it turned out, Burkhart account manager Arne Valdez was a neighbor of his host family, and in time the two became acquainted. “I eventually got to know the neighborhood kids and their families,” he explains. “Arne would

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take me fishing and turned out to be a huge influence in my decision to enter the dental market and join Burkhart.” First Impressions: Tell us about your early days with Burkhart Dental. Louis Ullrich: I joined Burkhart in 2010 as an account manager. Given that I was new to both the dental world and the work world in general, my manager decided I should train with the sales and service teams. I spent two days a week co-traveling with Arne on the sales side, and two days a week co-traveling with our service team. It was the best training possible, as I got

While some dentists continue to value a long-term relationship with their distributor rep and like to know a technician will be available to attend to their needs when there is a problem, others prefer ordering their supplies online. Sales reps will have to sell their differentiators to gain their customers’ business. to learn the industry from both perspectives, and my knowledge of dental equipment and supplies grew tremendously. As an account manager, my primary role was to sell consumable supplies to customers, as well as to grow Burkhart’s supply business in Anchorage and the Kenai Peninsula. Anchorage is home to a large majority of the population. The Kenai Peninsula has about 30 dental offices spread out between the small towns of Homer, Anchor Point, Kenai, and Soldotna. First Impressions: When did you transition to your current role as an equipment specialist? Ullrich: In 2015, when an equipment specialist position became available, my manager asked me to consider the position. He


April 2018

First Impressions

felt it would be a good move for me, as well as the rest of the branch. For the past five years, I had enjoyed my work as an account manager and felt I did well selling equipment. This was partially due to the large geographical areas I covered. Some of our offices are very remote, and it can be difficult getting manufacturer and technology reps to visit them, so I covered most of the sales calls myself. After five years, I had grown my sales to a very comfortable level and easily could have continued down that path. At the same time, I was ready to try something new. First Impressions: How would you compare the challenges and the rewards of your work as a sales rep and an equipment specialist? Ullrich: It has been great working in both of these roles. For starters, Burkhart Dental Supply has been an incredible company to work for. We are privately held and our current president, Lori Isbell, is a great leader. Our company culture and customer focused approach is truly unique. That said, my biggest challenge as an account manager was acquiring the large knowledge base necessary to succeed. Sales reps must be knowledgeable about dental products, dental anatomy, dental terminology, how their dental customers use the supplies and equipment, the Burkhart ordering systems and more. I still feel like I learn something new every day. I don’t think it’s possible for anyone to know it all in this field! My greatest challenge as an equipment specialist has been to learn the construction aspect of the equipment installation process. I’ve had to familiarize myself with the utility terms, as well as the requirements for each piece of equipment, and then communicate that to each set of contractors – including electricians and plumbers – for each project. Since each project involves a new set of contractors, we must constantly teach and inform them about what utilities we want, and where they must be installed. First Impressions: What have been some of the biggest changes you have encountered in the dental products sales industry? How have you addressed them? Ullrich: I have seen some major technological changes. When I began work in 2010, we sold digital panoramic x-ray units and converted many film-based offices to digital practices. Today, we find most customers are no longer interested in 2D digital panoramic units, but rather 3D CBCT units. And, whereas 3D CBCT units cost well over $100,000 in 2010, today they cost as little as $65,000 and are becoming a standard of care in the dental office.

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

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realize the value we bring to their offices, but given this is becoming an online world, distributors must adapt their business model.

Dr. Guy Burk, Louis Ullrich, Dr. Scott Laudon, Dr. Dustin Slunnaker, Jason Debaugh

The introduction of intra-oral impression scanners has also evolved since I joined the dental industry. Most offices relied on analog impression material when I started; today, most offices use a digital impression scanner. As the technology has evolved, the impression process has become simpler, faster and easier for patients. Our doctors prefer digital scanning, as it shows patients they are technology leaders and leads to increased case acceptance. With regard to consumables: Smartphones, the Internet and the introduction of online purchasing to the dental market have made it easier for staff to search for – and price – products online. This can work to the advantage – or the disadvantage – of supply reps. At Burkhart, we bring more value to our offices than simply a good price on consumable supplies. Most doctors


April 2018

First Impressions

Today, we transmit our orders online or through our laptops, whereas 15 years ago, reps often faxed or called in their orders. And, technological advances have definitely made information more accessible.

First Impressions: Would you say sales reps and equipment specialists today have it easier or harder than they did 10-15 years ago? Ullrich: I think all dental sales reps face unique challenges today, as they did 10-15 years ago. Today, we transmit our orders online or through our laptops, whereas 15 years ago, reps often faxed or called in their orders. And, technological advances have definitely made information more accessible. For instance, when I started out, I ordered every catalog from every manufacturer and kept a library of catalogs in my car in case I needed immediate information. I would bring a large, heavy briefcase filled with manufacturer catalogs on sales calls, which I could refer to when my customers had questions. This put a lot of strain on me physically. Now, I Google information on my smartphone and can get most of the answers I need very quickly. That said, it’s become challenging to stay on top of the constant changes in equipment technology. While some dentists continue to value a long-term relationship with their distributor rep and like to know a technician will be available to attend to their needs when there is a problem, others prefer ordering their supplies online. Sales reps will have to sell their differentiators to gain their customers’ business. Their persistence should lead to a long-term relationship with their customers.


Evacuation Line Maintenance Clean evacuation lines

ensure that suction lines are safe and fully functioning. Proper maintenance requires only a small time investment on the part of the dental staff. By consulting with the manufacturer to ensure proper cleaning protocols are followed and the right cleaning products are used, suction lines will remain free of debris build-up, the suction flow will be uninterrupted and patients will receive the best possible care.


April 2018

First Impressions

Start a discussion In recent years, more cleaners have become available that feature a neutral pH, making them compatible with the office’s amalgam separator. Natural ingredient-based products have also been

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Surface Disinfection

Instrument Cleaning

Skin & Hand Protection

Equipment Maintenance

AT-M Lines FirstImp 4-18.indd 1

3/13/2018 10:04:52 AM

introduced and will be further evaluated for use in the next several years. Still, some dentists have been reluctant to use them, objecting to the time investment and the risk of spillage. In addition, dentists might object to the cost of the cleaner or the need to adjust to a new dosage when switching to a new product. However, cleaning suction lines daily for both dry and wet vacuum systems is necessary to remove and prevent debris build-up and ensure proper suction flow. Distributor sales reps can show their customers which solutions are most economical by breaking down the actual cost per cleaning. They should also review the product label and instructions to ensure the practice uses the cleaner appropriately. Generally, the use of a non-foaming cleaner is recommended for use with dry vacuums, as foam cleaners tend to leave the turbine coated with residue and debris, leading to lower performance, loss of suction and eventual pump failure.

Sales reps can initiate a discussion of evacuation line maintenance with their dental customers by asking: • “Have you noticed a decrease in suction?” • “How often do you clean your evacuation lines?” Dental providers should be aware of CDC recommendations to keep suction lines disinfected daily in case backflow occurs when using a saliva ejector. For more information visit In addition, reps can direct their customers to the book Infection Control and Management of Hazardous Materials for the Dental Team, which states: High-volume evacuation (HVE) during the use of rotary equipment and the air/water syringe greatly reduces the escape of salivary aerosols and spatter from the patient’s mouth, which reduces contamination of the dental team and nearby surfaces. One should clean the HVE system at the end of the day by evacuating

The dental team member must wear gloves, masks, protective eyewear and protective clothing when cleaning or replacing these traps to avoid contact with patient materials in the lines from splashing and direct contact.

First Impressions

April 2018



a detergent or water-based-detergent disinfectant through the system. One should not use bleach (sodium hypochlorite) because this chemical can destroy metal parts in the system. One should remove and clean the trap in the system periodically. A safer approach, however, is to use a disposable trap. These traps may contain scrap amalgam and should be disposed of properly.

The dental team member must wear gloves, masks, protective eyewear and protective clothing when cleaning or replacing these traps to avoid contact with patient materials in the lines from splashing and direct contact. Disinfection of the trap by evacuating some disinfectant-detergent down the line, followed by water, is best before one cleans or changes the trap.

Dental effluent guidelines Mercury pollution is widespread and a global concern that originates from a number of sources, including dental offices. In fact, dental clinics are considered to be the main source of mercury discharges to publicly owned treatment works (POTWs), according to the Environmental Protection Agency (EPA). According to EPA estimates, approximately 103,000 dental offices use or remove amalgam in the United States, and almost all of these send their wastewater to POTWs. Furthermore, dentists discharge approximately 5.1 tons of mercury each year to POTWs, most of which is subsequently released to the environment. Mercury-containing amalgam wastes generally find their way into the environment when new fillings are placed or old mercury-containing fillings are drilled out and waste amalgam materials that are flushed into chair-side drains enter the wastewater stream. Mercury entering POTWs frequently

Mercury from waste amalgam therefore can make its way into the environment from the POTW through the incineration, landfilling or land application of sludge, or through surface water discharge.

partitions into the sludge – the solid material that remains after wastewater is treated. Mercury from waste amalgam therefore can make its way into the environment from the POTW through the incineration, landfilling or land application of sludge, or through surface water discharge. Amalgam separators are regarded as a practical, affordable, available technology for capturing mercury and other metals, before they are discharged into sewers that drain to (POTWs). Once captured by a separator, mercury can be recycled. In July 2017, the EPA passed its final rule specific to Best Management Practices for Dental Amalgam Waste, prohibiting the use of bleach or chlorine-containing cleaners that may lead to the dissolution of solid mercury when cleaning chair-side traps and vacuum lines. The rule says, “…vacuum lines that discharge amalgam process wastewater to a POTW [publicly owned treatment works] must not be cleaned with oxidizing or acidic cleaners, including but not limited to bleach, chlorine, iodine and peroxide that have a pH lower than 6 or greater than 8.” (40 CFR 441.30(b)(2)). EPA expects compliance with this final rule will reduce the discharge of mercury by 5.1 tons each year, as well as 5.3 tons of other metals found in waste dental amalgam to POTWs. For more information visit the EPA website: https://

Editor’s note: Sponsored by Air Techniques.

Resource: Miller CH. Infection Control and Management of Hazardous Materials for the Dental Team, 5th edition. Elsevier/Mosby Publishers. Page 181. Editor’s note: Sponsored by Air Techniques.


April 2018

First Impressions

Waterline Compliance Waterline disinfection helps ensure a safe patient visit. BY LAURA THILL

Improperly or poorly treated waterlines can place dental patients and

(CFU) counts,” Keefer continues. “For the past 50 years, Crosstex has been staff at risk for infection, as well as create a liability risk for the practice. Some committed to focusing on safer patient dentists may believe they are taking sufficient steps to reduce the risk, when, in care through innovative, high-quality fact, they are not. Using distilled water, cleaning bottles daily and refilling them solutions to ensure maximum compliwith fresh water, and installing filters are not enough, according to experts. And, ance, in addition to offering an outstandwhile waterline cleaner tablets provide a good start, total compliance is required ing patient experience. It is critical for a each time the water bottle is filled, and often the practice doesn’t follow up to client to understand the science behind ensure tablet protocols are followed consistently. the product, as well as following the validated product instructions for use (IFUs) for best performance.” Once the source water – whether it is tap, filtered or distilled Indeed, the performance of a product is only as good as – reaches the narrow bore tubing of the dental unit waterlines, the accuracy of implementation according to the product IFUs, a perfect storm for biofilm growth develops, notes Leann KeefKeefer continues. “Compliance with DUWL treatment and the er, RDH, MSM, director, educational and professional relations, manufacturer’s IFUs is an important safety issue for the patient, Crosstex. At the same time, microorganism counts exceeding staff and practice. The IFUs address the comprehensive DUWL the recommended 500 CFU/mL in the DUWL conflicts with the treatment protocol, which may include the product as well as standard best practices of infection prevention and control. “Waissues of frequency related to shocking recommendations and terborne pathogens exist in all forms of water that are not sterile, monitoring of CFU count. If a practice is only implementing one including distilled,” she says. “To quote a highly respected colof three recommended steps or compromises on the frequency league, Dr. John Molinari, ‘If you’re not doing anything to treat of treatment, the product is not being used in accordance with the dental unit water, it’s contaminated!’” Ignoring water line the IFUs.” (Daily-use products have a detailed list of protocols, treatment is neither ethical nor acceptable, she adds. which must be followed daily, weekly and quarterly to assure “Dental unit waterlines (DUWL) must be effectively and efficiently effective treatment outcomes.) treated to maintain acceptable safe and approved colony-forming-unit

First Impressions

April 2018



Addressing best practices As a leader in infection prevention and control, Crosstex is committed to scientifically based programming to address best practices of infection prevention to provide a safe dental visit for the patient, clinician and the practice, says Keefer. Indeed, the company is a big believer in providing its dental customers with strong educational programs and sound solutions to help them protect their patients and staff. There are several DUWL treatment options available to dentists, including: • Intermittent. Routine chemical shocking protocol. • Continuous. Tablet protocol. • Automated. Cartridge delivery protocol.

By providing educational resources to clinicians and distributor field sales reps and service technicians, and by arming sales reps with patient resources to share with customers, “Crosstex has created educational touchpoints in every arena of safe dental unit waterlines,” says Keefer. “Crosstex is an AGD PACE-approved provider with CEU programs at national meetings and on-site practice-based learning events, and through VIVA Learning for live and on-demand CE webinars. Our Client Care team and educational toll-free STERILE Helpline (1-8558-STERILE) are ready to address both clinical and regulatory questions.” (Visit for the complimentary on-demand DUWL CE webinar.)

Easy maintenance Dentists appreciate the value of infection control protocols, including waterline treatment. But, some may express concerns about managing the compliance process and maintaining records. Once installed, however, the DentaPure cartridge requires no monitoring or shocking for 365 days, or 240L of water usage if records are maintained, notes Keefer. “If an office is concerned about monitoring CFU counts, we recommend independent – Leann Keefer, RDH, MSM, director, testing by an outside laboratory,” she educational and professional relations, Crosstex says. “For offices that are concerned that the iodine level stays within the range provided in the DentaPure cartridge IFU, Crosstex offers iodine test strips.” Testing frequency – both for “While each method, used in compliance with IFUs, can be CFU counts and iodine levels – varies by practice, she adds. effective in managing CFU count, automated treatment with the annual installation of a Crosstex DentaPure® cartridge provides Crosstex strongly recommends the following best practices in continuous treatment for dental unit waterlines, reducing the conjunction with use of its DentaPure cartridges and Liquid need for daily or weekly intervention,” says Keefer. “DentaPure Ultra™ Solution: cartridges reduce staff time while increasing compliance with • Flushing for 20 to 30 seconds between patients. protocol, decreases the incidence of human error, and reduces • Sterilizing all handpieces after each use. the exposure of the staff to potentially caustic and toxic chemi• Emptying independent water bottles nightly and setting cals.” Together with DentaPure cartridges, Crosstex Liquid Ulthem upside down to dry to avoid biofilm growth from tra® Solution helps ensure compliance with EPA standards for untreated water remaining in the bottle. potable water, she adds. “DentaPure cartridges are EPA regis• Wiping down the outside of the cartridge with a clean tered to provide water ≤200 CFU/mL. And, when used as directpaper towel before replacing the bottle. ed, Liquid Ultra is EPA registered to provide water ≤500 CFU/mL • Filling bottles with fresh water (tap or distilled) each and it reportedly is the only EPA approved in-line product that morning before each use. kills biofilm bacteria,” she says.

“Dental unit waterlines (DUWL) must be effectively and efficiently treated to maintain acceptable safe and approved colony-forming-unit (CFU) counts.”

Editor’s note: All DentaPure claims based on use with potable water.


April 2018

First Impressions

Clean Water. Clear Choice.™

One simple installation. One year of compliant dental unit water.*

© 2018 Crosstex International, Inc. 0318 DADV00032

• Cartridge installs in minutes • Meets and exceeds microbiological water standards • Non-toxic, non-corrosive • Not restricted by the EPA Rule BMP for Dental Amalgam Waste DP365M: For waterlines plumbed directly to city water Installs onto incoming lines with included fittings.

DP365B: For independent water bottles Easily self-installed onto existing pickup tube with included fitting.

All claims made based on use with potable water. *Or 240L of water if usage records are kept. End cap color may be black or white.

DentaPure® and Clean Water. Clear Choice.™ are trademarks or registered trademarks of Crosstex International., a Cantel Medical Company.


0 / 100 / 63 / 29 PMS 201C

Waterborne opportunistic pathogens in DUWLs While some organisms have been identified in dental unit water as a result of back-flow from patients (oral microorganisms) the majority of microbial species found in DUWL output water are Gram-negative aerobic (without oxygen) heterotrophic (live off of others/carbon loving) mesophilic (heat loving) environmental (waterborne) bacterial species. These opportunistic waterborne bacteria attached to the inner-surface of the tubing with an insoluble slime layer. As the microorganisms grow and multiply, they create a more complex and potentially pathogenic environment. Eventually pieces of the biofilm may break off and be carried through the dental tubing via the waterflow eventually delivered to the patient’s mouth. In the past it was recommended to flush dental waterlines at the beginning of the clinic day for several minutes to reduce the microbial load. However, studies have demonstrated this practice does not affect biofilm in the waterlines or reliably improve the quality of water used

during dental treatment. Therefore, this has not been recommended since the publication of the CDC Guidelines for Infection Control in Dental Health-Care Settings in 2003. It is still necessary to discharge water and air for a minimum of 20 to 30 seconds after each patient, from any device connected to the dental water system that enters the patient’s mouth (e.g., handpieces, ultrasonic scalers and air/ water syringes). This procedure is intended to physically flush out patient material that might have entered the turbine, air or waterlines. Even though the initial flush of the day is no longer indicated, it’s still a good idea to perform a quick flush of the lines before each patient to ensure everything is working (e.g., that the air/water syringe is attached correctly and water/air is flowing) before beginning patient treatment. (Reference: Centers for Disease Control and Prevention (CDC), Guidelines for Infection Control in Dental Health-care Settings, 2003. MMWR 2003; 52(No. RR-17):1–66.

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Safe dental water… …should be a priority at every practice. The quality of dental unit water has been a topic of discussion and research for many years. Indeed, outbreaks of infection linked to the dental waterline can be a health risk for patients and a liability risk for dental practices. It’s the ethical and professional responsibility of dental practitioners to provide safe dental water to their patients, and manufacturers, such as Hu-Friedy, make it a priority to keep them informed and provide optimal solutions for helping clean and maintain water used at their dental practice. Hu-Friedy offers a number of educational resources, including live continuing education courses, articles, on-demand webinars, step-bystep guides and customer service support. (To view their online resources, please visit: infection-prevention-resources.) According to the 2003 CDC Guidelines, “Dental unit water that remains untreated or unfiltered is unlikely to meet drinking water standards (303-309).” Dentists have several options for ensuring safe water standards at their dental practice, such as the following: • Filtration devices with in-line filters to remove bacteria before water enters the handpiece or other devices attached to the waterline. • Independent reservoirs with chemical germicides or cleaners to remove microbial accumulations and prevent attachment of microorganisms, such as Hu-Friedy’s Team Vista Dental Unit Waterline Cleaner. • Devices or cartridges that provide a slow release of chemicals. Whichever method is chosen, it is critical to monitor waterlines on a periodic basis to ensure their efforts and product are working.

Common misconceptions Contrary to what some dental professionals may realize, ALL dental waterlines – regardless of how new or old they

are – must be cleaned and maintained. According to the CDC, “Research has demonstrated that microbial counts can reach <200,000 colony-forming units (CFU)/mL within 5 days after installation of new dental unit waterlines (305), and levels of microbial contamination <106 CFU/mL of dental unit water have been documented (309,338). These counts can occur because dental unit waterline factors (e.g., system design, flow rates, and materials) promote both bacterial growth and development of biofilm.” Additionally, it’s essential for dental offices to understand that ensuring their source water meets CDC standards is a two-step process that involves both cleaning and maintenance. To help prevent waterborne organisms from attaching, colonizing and proliferating on the inner surfaces of water tubing, a complete dental unit waterline system should be used. Complete systems to control the quality of water delivered to patients include both periodic cleaning AND routine maintenance. The CDC offers several steps to help dentists ensure the safety of their dental water: • Use water that meets EPA regulatory standards for drinking water. • Consult with the dental unit manufacturer for appropriate methods and equipment to maintain the recommended quality of dental water. • Follow recommendations for monitoring water quality provided by the manufacturer of the unit or waterline treatment product. • Discharge water and air for a minimum of 20-30 seconds after each patient from any device connected to the dental water system that enters the patient’s mouth. • Consult with manufacturer on the need for periodic maintenance of anti-retraction mechanisms.

Editor’s note: Sponsored by Hu-Friedy.


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Hu-Friedy’s promise to help you perform at your best is at the core of everything we do, which is why we’re proud to bring you the sharpest, longest lasting scaler on the market: EverEdge 2.0. Engineered to be better than ever, so you can be, too.

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Dental Unit Waterlines:


Itâ&#x20AC;&#x2122;s no secret in 2018 that dental unit waterline (DUWL) cleanliness is im-

portant. Every trade publication, tradeshow and continuing education summit offers some sort of crash course on the subject. The bacteria problem is widespread and omnipresent regardless of the practice type or equipment employed. If it runs water, the potential to be a problem exists. Given their nature, dental waterlines will grow bacteria beyond the 500 colony forming units per milliliter drinking water standard without some level of shock and maintenance.


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Opportunistic bacteria and the subsequent biofilm they produce are everywhere in the natural world. Every dental unit in use today employs a network of tubing to deliver both air and water to the handpieces. The typical tubing used in a dental chair is narrow in diameter


BUILT-IN SHOCK TREATMENT BUILT-IN SHOCK TREATMENT Kills existing odor-causing bacteria. Kills existing odor-causing bacteria. HASSLE-FREE HASSLE-FREE Eliminates the need to purge waterlines at the Eliminates the need to purge waterlines at the beginning or the end of the day. beginning or the end of the day. ≤10 CFU/ML EPA CLAIM ≤10 CFU/ML EPA CLAIM EPA tested and approved for disinfection 50x lower EPA tested and approved for disinfection 50x lower than the ADA and CDC guidelines. than the ADA and CDC guidelines.


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and low in volume. This proportional relationship means the internal surface area is much greater relative to the volume of water flowing through the tubing. The smaller the tubing diameter, the larger the internal surface. This large volume of surface area gives bacteria and biofilm plenty of room to establish themselves. Bacteria and pathogens are opportunists, and they will exploit the nature of dental tubing to their advantage. According to The Organization for Safety, Asepsis, and Prevention (OSAP), “This proportional increase in the amount of potential biofilm relative to a given water volume is one of the major factors influencing dental water quality in unrelated systems.”1 Once biofilm are established, they can be difficult to eliminate. If left unchecked, biofilm will exhibit a resistance to common disinfectants, making the situation even more problematic.7 Consider other growth factors unique to dental systems, such as water


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temperature, flow rates and frequent stretches of stagnation. The culmination of all these factors allows the bacterial load in the waterline to exceed the CDC and EPA drinking water standard of 500 CFU/ml. So why is this a problem? According to OSAP, “As many as nine potentially pathogenic organisms associated with opportunistic wound and respiratory infections have been isolated from dental unit water systems.”1 When coolant and irrigant water is used in conjunction with a high speed dental handpiece, the contaminated water is aerosolized along with the bacteria. Now you really have a problem! If patients or the dental team inhales these water droplets, they’ve now been exposed to whatever was growing in the dental unit. There’s also the good old fashioned way of exposed tissue (or dental pulp) being infected when the site is irrigated with contaminated water. Either way, serious infections can be the result of a contaminated DUWL. So how

can clinicians mitigate these risks? They can start with the water being supplied to the dental practice. Most clinicians are not aware that municipal tap water could be contributing to their bacteria problems. Public water works that deliver municipal tap water are prone to contamination and breaches in their own water quality standards. A common watermain break or leak presents an opportunity for pathogens to gain access to the public works. According to a 2012 report, these types of failures have been the cause of several bacterial and viral outbreaks of Salmonella, Campylobacter, Shigella, E. coli O157:H7, Cryptosporidium, Giardia and Norovirus.2,3 As of 1971, the Centers for Disease Control and Prevention (CDC), U.S. Environmental Protection Agency (EPA) and the Council of State and Territorial Epidemiologists (CSTE) have been tracking and quantifying these waterborne disease outbreaks in the United States. The most interesting insight from the data

Most clinicians are not aware that municipal tap water could be contributing to their bacteria problems. Public water works that deliver municipal tap water are prone to contamination and breaches in their own water quality standards.

they provide is that over the 36-year period from 1971 to 2007, “a trend analysis found a statistically significant decrease in the annual proportion of reported deficiencies that were associated with the inadequate or interrupted treatment of water by public water systems.”4 Conversely, the amount of outbreaks related to flaws in premise plumbing have increased in that time.4 Privately managed water treatment – or premises treatment – are technically outside the jurisdiction of a water utility. The liability falls to building managers to implement a strategy for maintaining waterlines after the meter. According to the American Society for Microbiology, “Health care settings, such as hospitals and nursing homes, were the second most common outbreak location in community systems, highlighting the need for continued vigilance to ensure provision of safe water to locations that serve populations that are more vulnerable, such as hospitalized patients or nursing home residents with preexisting medical conditions.”4 For dental professionals in large healthcare facilities, it is certainly worth speaking with building managers about the plans for water treatment within the building. Systems of water quality monitoring and intermittent testing should be in place where the consequences could be serious.

Maximum chemical control In 2015, reports began to circulate that a cluster of Mycobacterium abscessus infections had been identified in Atlanta, Ga. after nine pediatric patients were hospitalized in the same facility. The CDC reported that the Georgia Department of Public Health (GDPH) initiated an investigation, which revealed that all of the patients (between the ages of 3-11) had previously undergone a pulpotomy procedure at the same dental clinic. Upon visiting the clinic to evaluate their infection control policies, GDPH staff indicated the practice used tap water for irrigation during the pulpotomies. The report also indicated the practice lacked any level of monitoring or disinfection efforts as directed by the chair manufacturer. The report concluded that all seven operatories had bacterial counts above the 500 colony forming unit (CFU) drinking water standard and M. abscessus was identified in all samples.5 If a dentist intends to use their municipal water for dental water – and, yes, there is a difference – it would be advisable to have some level of water quality analysis before selecting the product. Variations in tap water quality are virtually infinite and, therefore, the dental practice should not rely on tap water for consistent disinfection results. The presence of municipal disinfectants and additives, such as chlorine and fluoride, complicates things further if the practice is trying to manage the chemistry, as it should to get the best results. By failing to do

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so, the dental practice has a concoction of different chemicals and additives mixing in the waterline. The byproduct of these unwanted mixtures is called precipitates, and their presence indicates the diminished effectiveness of whatever exists in the water to control microbes. So what is the solution? To attain maximum chemical control, distilled quality water is best. That said, distilled water from a distiller is not always optimal for dental water. The nature of distillation requires that one heat the water to remove impurities. This hot distillate is now primed for recolonization by bacteria. Without immediate waterline treatment, this water will most assuredly be contaminated. Without the presence of a continuously present residual disinfectant, that water will most assuredly be a

Contaminated dental unit waterlines are a real threat to patient and staff safety. Their design, the nature of dental procedures and the conditions within the dental operatory prime them for bacterial colonization. We know the problem can be exacerbated by using municipal water instead of purified or distilled water, and the case data proves this point. breeding ground for bacteria. Distillers themselves are often the source of contamination for many offices, as once the storage tank is contaminated the water is then distributed along with the bacteria to the entire office. The best strategy is a point-of-use purification system using deionization to remove all the impurities without heating the water. Ultraviolet disinfection can then be employed to drastically lower the existing bacterial load with proven effectiveness.8 The water would then receive a low concentration of a residual disinfectant. The final product is water that is neutral in pH, contains less than 10 ppm total dissolved solids, is disinfected and contains some variety of residual disinfectant. Now the water is pure and bacteria free. So the treatment process is complete, right? Not even close! We haven’t gotten


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to the most important part – the dental water use protocols. Without sound operating protocols, everything the dental practice has done up to this point would be for not.

Dental water use protocols

Manufacturers spend unmentionable amounts of money on development, EPA registration and validation for their products. The EPA label will run down all the necessary steps needed to get the advertised disinfection level. Clinicians should not go rogue on these protocols! When it comes to quality assurance (QA), OSAP recommends procedures that flush out user error.6 Let’s face it, people can make mistakes. Minor investments like TDS hand meters will allow some level of protocol QA. For example, when using distilled water in their bottles, clinicians should randomly check the TDS count and ensure the result is less than 20 ppm. If it’s greater than 20 ppm, they can assume the water in that bottle is not distilled and that someone has botched the procedure for refilling it. Protocol consistency and quality failsafes are fundamental to getting all of this waterline stuff done right. Consistency leaves nothing to chance. This is also important, as manufactures design their products to work within certain parameters. We’ve already discussed the variability in water

having the desired effect. It can be something as simple as a change in the daily staff use or as extensive as a complete overhaul of the regimen at large. Contaminated dental unit waterlines are a real threat to patient and staff safety. Their design, the nature of dental procedures and the conditions within the dental operatory prime them for bacterial colonization. We know the problem can be exacerbated by using municipal water instead of purified or distilled water, and the case data proves this point. The most

chemistry across the spectrum. Deviations in protocol, like the example above, could mean the dental practice is no longer operating within those parameters and, subsequently, it may have contributed to contamination in the unit. So what is compliance under the current standards? The acceptable standard set by the CDC and the ADA for bacterial content in a dental unit is ≤500 CFU/ml. Compliance is not a state of mind; it’s a state of being. The notion that purchasing a product and following the instructions puts one in compliance is just wishful thinking. A complete and thorough waterline assessment performed by a 3rd party lab specializing in dental water microbes will provide all the information necessary. TDS, pH, and HPC counts in CFU/ml are the general markers of waterline cleanliness. These test results can be used to make adjustments to the waterline protocol or confirm that clinician’s efforts are

Manufacturers spend unmentionable amounts of money on development, EPA registration and validation for their products. The EPA label will run down all the necessary steps needed to get the advertised disinfection level. Clinicians should not go rogue on these protocols! important takeaway from this piece is that whatever clinicians do, they should be consistent. They should read manufacturers guidelines and follow them, as there may be something they’ve been missing. When they feel like everything is going well, they shouldn’t assume it is. Rather, they should order a test and know for sure. If clinicians miss the mark, they should reevaluate their plan, retrain their staff and retest to confirm the change. Attaining the <500 CFU/ml standard in dental effluent water is the culmination of forethought, execution, consistency and vigilance. No excuses!


1. B erdnash, Helene, et al. “Dental Unit Waterlines: Check Your Dental Unit Water IQ.” Dental Unit Waterlines - OSAP, 2. Ingerson-Mahar, M.; Reid, A. Microbes in Pipes: The Microbiology of the Water Distribution System A Report on an American Academy of Microbiology Colloquium; ASM Academy: Boulder, CO, USA, 2012; p. 26. 3. R amírez-Castillo, Flor, et al. “Waterborne Pathogens: Detection Methods and Challenges.” Pathogens, vol. 4, no. 2, 2015, pp. 307–334., doi:10.3390/pathogens4020307. 4. C  raun, Gunther F., et al. “Welcome to CAB Direct.” CLINICAL MICROBIOLOGY REVIEWS, vol. 23, no. 3, July 2010, pp. 507–528., abstract/20103246391. 5. P eralta, Gianna, et al. “Morbidity and Mortality Weekly Report (MMWR).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 25 Aug. 2017, - Dental Unit Waterlines 6. A. Bridier, R. Briandet, V. Thomas & F. Dubois-Brissonnet. “Resistance of bacterial biofilms to disinfectants: a review” Biofouling Vol. 27 , Iss. 9,2011 7. C  hevrefils, Gabriel, et al. UV Dose Required to Achieve Incremental Log Inactivation of Bacteria, Protozoa and Viruses. UV Dose Required to Achieve Incremental Log Inactivation of Bacteria, Protozoa and Viruses, Trojan Technologies Inc., 2006.

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Dental manufacturers have

set the bar high when it comes to quality control, efficiency and safe work settings. For some, maintaining U.S. manufacturing facilities has enabled them to meet large orders more efficiently, closely monitor product reliability and oversee the value they deliver to their dental customers.


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International Presence, Americanmade By producing products locally, Crosstex maintains high product standards and customer support.

Since its start

in 1953, Crosstex, a division of Cantel, has evolved from a disposable towel and bib manufacturer to an international leader in infection prevention and control entities. Yet, the company continues to manufacture 95 percent of its products in the United States, according to Leann Keefer, RDH, MSM, director, corporate education & professional relations, Crosstex. “Crosstex is committed to patient safety and client satisfaction,” she says. “We stand behind every product, from our Comfort Plus saliva ejectors to our DentaPure cartridges.” By maintaining local production facilities, Crosstex can constantly monitor its operations, ensuring continual improvement with regard to both product quality and worker conditions. “Our management team schedules frequent walk-throughs to evaluate safety conditions, work practices and procedures,” she explains. As a result, they’ve been able to upgrade many products, including saliva ejectors. “Our newer patented Comfort Plus® Premium Saliva Ejectors are kinder and gentler,


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“Producing our products in the United States demonstrates our commitment to a better quality of life for local workers and stronger economies for the communities in which we are located.” – Leann Keefer, RDH, MSM, director, corporate education & professional relations, Crosstex

and designed to reduce patient discomfort, optimize fluid removal and minimize trauma to mucosal tissue. And, our most recent acquisition – SafeFlo saliva ejectors – has mitigated the risk of backflow and cross-contamination. “We’ve increased our investment in research and development, and we take pride in the quality, innovation, performance and evidence-based science behind our products,” Keefer says. “We’re much more than a company that sells face masks; we created SecureFit masks to provide the best levels of protection (ASTM F2100-11) based on the quality of materials used and designed to offer maximum 360° protective fit. “Crosstex has a loyal client base of clinicians and dealer/distributor partners who have access to a broad range of quality,

economical products,” she points out. “While it’s challenging to compete with lower overseas labor costs, Crosstex has invested in best technology and advanced manufacturing processes capable of producing consistent precision quality and high volume infection control disposables. Our clients choose Crosstex because they are confident we’ll deliver and support our products as promised. As a dental hygienist, throughout my clinical and academic career, I’ve always believed in Crosstex products!”

There’s a sense of pride in producing – as well as purchasing – an American-made product, notes Keefer. Clinicians expect and support a high standard of quality and working conditions when they buy local products, she points out. “Products made in America must follow FTC and FDA consumer protection laws and safety standards,” she says. “According to the Federal Trade Commission, the product’s final assembly or processing must take place in the U.S. in order

A good citizen

“While it’s challenging to compete with lower overseas labor costs, Crosstex Crosstex is committed to retaining – as well as growing – U.S. based jobs. has invested in best technology and advanced manufacturing processes “Producing our products in the United capable of producing consistent precision quality and high volume States demonstrates our commitment to infection control disposables. Our clients choose Crosstex because a better quality of life for local workers and stronger economies for the comthey are confident we’ll deliver and support our products as promised.” munities in which we are located,” says – Leann Keefer, RDH, MSM, director, Keefer. “We have six manufacturing facorporate education & professional relations, Crosstex cilities (three in New York, and one each in Georgia, California and Pennsylvania). to carry the distinction, although the agency permits the incluJorgen Hansen, the president and CEO of Cantel, recently ansion of a percentage of imported parts and materials,” she connounced that 543 new team members joined our company. In tinues. “Crosstex has a solid supply chain, with the majority of addition to offering American-made products to dental profesproducts fabricated from materials that are made in the United sionals, Cantel and Crosstex offer support to those in need in States, with final assembly and packaging done domestically,” the form of product and financial donations, such as hurricane she adds. relief to affected areas.”

The value of American-made Shipping products from overseas is costly and takes considerable time, according to Leann Keefer, RDH, MSM, director, corporate education & professional relations, Crosstex. But, that’s not the only reason why the company manufactures over 95 percent of its products in the United States. “A growing number of clinicians are deliberately seeking domestically-made infection control products for a number of different and compelling reasons,” she says. Among them: • Trust and familiarity. • Consistent quality and safety. • Great value for the dollar.

• Attentive service and reliability. • Sense of patriotism. • Social conscience. • Support for the U.S. economy. According to a 2012 international survey by the Boston Consulting Group, over 80 percent of U.S. respondents said they prefer purchasing items made in America, notes Keefer. Over 60 percent of respondents said they would be willing to pay as much as 10 percent more for those products (Consumer Reports).

Editor’s note: Comfort Plus®, SAFE-FLO®, SecureFit® and DentaPure® are registered trademarks of Crosstex International, Inc., a Cantel Medical Company.

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Quality Control When products don’t work, neither do dentists.

For manufacturers like Engle Dental, producing equipment in United States has made it easier to ensure quality standards. “Dentists rely on their operatory equipment daily,” says Carolyn Buck, national sales manager, Engle Dental. “Producing equipment in our own factory and sourcing local vendors has helped us meet large orders more efficiently, with complete control over the quality of our products.” When your factory is an ocean away, it’s simply more difficult to oversee production, she points out. “We are lucky to be in the United States, where most of the leading technology is accessible to us,” she says. 32

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Particularly with regard to dental delivery systems, chairs and lighting, American-made products continue to invoke a sense of confidence in dental customers, Buck continues. “When dentists tour our factory, they’re impressed to see the process by which we manufacture raw material into parts for chairs, delivery

MADE IN THE U.S.A. be reliable and durable throughout the years. Our model allows us to stay competitive with our pricing, even compared with equipment manufactured overseas. “We have noticed that consumers in many industries have shifted from a price-based purchasing mindset to a value-based one. Dentists realize that operatory equipment is an investment – one that should last as long as 10 or 15 years. Engle Dental has manufactured chairs that dentists have relied for 30 years or longer! “America has always been a leader in innovation,” says Buck. “Here, new products will continue to be developed and new technologies will continue to be adopted. At Engle, we recognize that a huge part of delivering high quality products involves introducing our dental customers to new products and technology designed to fit their evolving needs. As a result, we are the only manufacturer with a hydraulic Traverse dental chair that provides dentists with 10.25 inches of extra room, making it easier for patients, dentists, hygienists and assistants to move throughout a small operatory more – Carolyn Buck, national sales manager, Engle Dental easily and efficiently. We also offer handcrafted upholstery that can be customized to each dentist’s style, with a heat and massage feature, logo embroidery, stitching styles and more systems or lighting. We have a fantastic team who takes great upholstery color options than other chair manufacturers offer.” pride in their work and has enabled us to deliver new and better products, such as our Traverse Chair.”

“Producing equipment in our own factory and sourcing local vendors has helped us meet large orders more efficiently, with complete control over the quality of our products. We are lucky to be in the United States, where most of the leading technology is accessible to us.”

The long run

Value-based purchasing To ensure their equipment is reliable and durable, Engle Dental “completes rigorous testing throughout production, as well as before shipment, to ensure everything is perfect before it reaches a dental office,” says Buck. “We find that it’s more cost effective in the long-term to produce a great product and get it right the first time. It might be cheaper to produce overseas, but shipping replacement parts back and forth isn’t.” Additionally, the Internet and social media make it easier than ever before for dentists to read product reviews. Manufacturers can’t “hide” from a poor product review, notes Buck. “Dentists realize that buying on price alone is not the key to saving money,” she says. “They want operatory equipment that will


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Given its long-term relationships with experienced employees and local vendors, for Engle Dental, “it makes more sense in the long run” to manufacture their products locally, notes Buck. “Ultimately, we can provide a better product and greater customer service by being American made. It’s an extra bonus that we get to live in the beautiful state of Oregon! “Dentists provide high quality service at reasonable prices to their neighbors,” she continues. “They are an integral part of the communities they serve, and they significantly improve the quality of life for many of their patients. They rely on our equipment to do this, so it’s our responsibility to provide durable and reliable operatory equipment. It’s a bonus that any time they purchase Engle operatory equipment, they support an American made product.”

Investing in the customer U.S.-based production helps Midmark maintain strong relationships with its dental customers.

For Midmark, building a trusting relationship with both dealers and

dentists is core to its business, according to Stephanie Woeste, director of dental marketing, Midmark Corporation. “Midmark has differentiated itself by investing in our expertise, craftsmanship, materials and our always-there-for-you support,” she says. “The Midmark brand is strong because we are known for what matters most – taking care of the customer.” For this reason, Midmark has continued its over-100-yearold tradition of investing in U.S.-based engineers, manufacturing personnel and “many other dedicated people on our team who help us deliver quality Midmark products,” Woeste explains. “While Midmark is proud of our international business where we manufacture in Italy and India, we only market products in North America that are built in the United States. The reasons are pretty simple. “Being close to our dealers and customers has many advantages,” she continues. “First, they can actually visit Midmark to see the equipment they are selecting first-hand in our showroom, work with our designers to complete the plans provided by the dealer, and tour our manufacturing plants to see how their new equipment will be made. They can even meet the teammates who make it. Then, when the order is placed, they can rely on efficient delivery, because there is no overseas shipping involved. Once doctors become Midmark customers, they can rely on U.S.-based support;

and dealers know that when service parts are needed, they are close at hand.”

Pride in Midmark products

Midmark has strategic locations across the United States to serve the medical, dental and animal health markets leveraging the skill sets prevalent in the respective communities, notes Woeste. “The dental products that Midmark is known for are designed, manufactured and assembled in three locations: Versailles, OH; Glasgow, KY; and Lincolnshire, IL. These communities have deep experience in the technologies and manufacturing processes necessary to produce quality equipment. Midmark benefits from that by being able to attract talented and loyal teammates, who keep the customer at the heart of everything we do. “There’s a recent survey result that I’m particularly proud of,” says Woeste. “We asked service technicians across leading distributors about their experiences with sterilizers and found that 94 percent of dental service technicians would recommend a Midmark sterilizer. That’s coming from people who have firsthand knowledge about sterilizer quality! That’s how I know we’re doing things right.”

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April 2018




A Look at OSHA The Occupational Safety and Health Administration (OSHA) plays an important role in the dental industry.

OSHA: It’s an organization that many dental employers fear! In fact, some

dentists do not fully understand the importance of OSHA regulations and believe they make if difficult to deliver high-quality dental care. However, non-compliance can lead to injury, illness or harm to employees. For that reason, dental practices make it their business to remain compliant with OSHA standards, often hiring quality assurance individuals to oversee compliance. This team is frequently charged with ensuring that OSHA standards are in place and being met throughout the practice. Furthermore, as a federal regulatory body, OSHA inspectors may appear at a dental practice unannounced and can issue citations and monetary fines for noncompliance and repeated offenses. These fines have recently increased, and they can be substantial, not to mention the potential damage to the practice’s reputation and credibility as a safe workplace.


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This article looks at OSHA’s history, inspection protocols and fees for noncompliance.

The history of OSHA In response to dangerous working conditions across the nation, and as a culmination of decades of reform, the bipartisan Williams-Steiger Occupational Safety and Health Act of 1970 was signed into law by President Richard M. Nixon. This law led to the establishment of the Occupational Safety and Health Administration

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(OSHA) on April 28, 1971. Since then, OSHA – along with state partners and employers, safety and health professionals, unions and advocates – has had a dramatic effect on workplace safety, showing a dramatic drop in fatality and injury rates. OSHA’s mission is to ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.1,2 According to history, accurate statistics were not kept early on, but it is estimated that in 1970 about 14,000 workers were killed on the job – a number that decreased to approximately 4,340 in 2009. At the same time, U.S. employment has almost doubled and now includes over 130 million workers at more than 8 million worksites. Since the passage of the OSHA Act, the rate of reported serious workplace injuries and illnesses has declined from 11 per 100 workers in 1972 to 3.6 per 100 workers in 2009. OSHA safety and health standards, including those for trenching, machine guarding, asbestos, benzene, lead and bloodborne pathogens, have prevented countless work-related injuries, illnesses and deaths.1

Inspections Federal OSHA is a small agency, but with the state partners there are approximately 2,100 inspectors responsible for the health and safety of 130 million workers, which translates to about one

1IMP150_0418 3/15/18 10:15 AM

compliance officer for every 59,000 workers.1,3 OSHA cannot inspect all 8 million workplaces it covers each year. The agency seeks to focus its inspection resources on the most hazardous workplaces in the following order of priority: 1. Imminent danger situations: Hazards that could cause death or serious physical harm receive top priority. 2. S  evere injuries and illnesses: Employers must report all work-related fatalities within eight hours, and all work-related inpatient hospitalizations, amputations or losses of an eye within 24 hours. 3. Worker complaints: Allegations of hazards or violations also receive a high priority. 4. R  eferrals of hazards from other federal, state or local agencies, individuals, organizations or the media receive consideration for inspection. 5. T argeted inspections: Inspections aimed at specific high-hazard industries or individual workplaces that have experienced high rates of injuries and illnesses also receive priority.

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April 2018



6. F ollow-up inspections: Checks for abatement of violations cited during previous inspections are also conducted by the agency in certain circumstances.4

positions represent 4 percent of OSHAâ&#x20AC;&#x2122;s total federal inspection force, which fell below 1,000 this past October.6,7

Fines In dental practices, the most common trigger for an OSHA inspection is a worker complaint or referral. A current or former employee can call in a complaint and, depending on a number of circumstances, including inspection history, if any, and the gravity of the complaint, an inspection can be triggered by this one phone call.5 Thus, it is prudent to treat employee concerns

In 2015, Congress passed the Federal Civil Penalties Inflation Adjustment Act Improvements Act to advance the effectiveness of civil monetary penalties and to maintain their deterrent effect. This law directs agencies to adjust their penalties for inflation each year using a much more straightforward method than previously available, and requires agencies to publish catch-up rules to make up for lost time since the last adjustments.8 In August 2016, for the first time since 1990, OSHA increased its fines â&#x20AC;&#x201C; by 78 percent. As of this date, the top penalty for serious violations rose from $7,000 to $12,471, and the maximum penalty for willful or repeated violations increased from $70,000 to $124,709. Then, effective January 2 of this year, OSHA increased its penalties again by 2 percent to adjust for inflation (as required by the Federal Civil Penalties Inflation Adjustment Act), with a maximum fine of nearly $130,000. The new fines apply to all violations that have occurred since November 2, 2015, with penalties assessed after January 2, 2018.9.10 Penalties such as these would have a significant financial impact on a dental practice of any size, including a large group practice or DSO. From October 2016 through September 2017, there were 87 citations from federal OSHA (state issued citations are not included in this number) to dental offices. Of those, 49 were related to the bloodborne pathogens standard and 21 were related to the hazard communication standard.11

Since the passage of the OSHA Act, the rate of reported serious workplace injuries and illnesses has declined from 11 per 100 workers in 1972 to 3.6 per 100 workers in 2009. seriously and make the necessary corrective action before the issue escalates into a formal complaint to OSHA. When dental staff feel that they are threatened in an unsafe workplace for any reason, management needs to take immediate action. Usually, OSHA conducts inspections without advance notice. However, employers have the right to require compliance officers to obtain an inspection warrant before entering the worksite.4 According to a national news report, OSHA has lost 40 inspectors through attrition since President Trump took office in January 2017, and as of early October 2017, the federal agency had made no new hires to replace them. The 40 vacant


Type of Violation

Penalty pre-August 2016

Penalty as of August 1, 2016

Penalty as of January 2, 2018

Serious Other-Than-Serious Posting Requirements

$7000 per violation

$12,471 per violation

$12,934 per violation

Failure to Abate

$7000 per day beyond the abatement date

$12,471 per day beyond the abatement date

$12,934 per day beyond the abatement date

Willful or Repeated

$70,000 per violation

$124,709 per violation

$129,336 per violation

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First Impressions

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Dental practices are busy places, but remember, the OSHA Act was put in place to protect all workers, including those in dental healthcare. A safe workplace is also an efficient workplace. Implementation of – and compliance to – the required elements of the bloodborne pathogens and hazard communication standards must be in place to ensure dental healthcare worker safety. Al-

though the there is a decrease in the number of OSHA inspectors, legitimate worker complaints will eventually be addressed. Dental employers should not risk the possibility of an inspection or a citation with the new fees. They should be proactive and follow the federal standards for providing and maintaining a high-quality, safe practice setting for all dental healthcare workers.

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

1. U S Department of Labor. Occupational Safety and Health Administration. Timeline of OSHA’s 40 Year History. Accessed January 17, 2018. 2. U S Department of Labor. Occupational Safety and Health Administration. OSHA Celebrates 40 years of accomplishments in the Workplace. OSHATimeline.pdf. Accessed January 17, 2018. 3. U S Department of Labor. Occupational Safety and Health Administration. Commonly used statistics. Accessed January 17, 2018. 4. U S Department of Labor. Occupational Safety and Health Administration. OSHA fact sheet. Accessed January 17, 2018. 5. G  arofolo R. OSHA compliance for the dental office. DentalTown; September 2014. Accessed January 17, 2018. 6. N  BC News. Accessed January 17, 2018. 7. OSHA Healthcare Advisor. General health and safety. Accessed January 17, 2018. 8. U S Department of Labor. Occupational Safety and Health Administration. OSHA national new release. Accessed January 18, 2018. 9. US Department of Labor. Occupational Safety and Health Administration. OSHA penalties. Accessed January 18, 2018. 10. O  SHA Healthcare Advisor. A rundown of new, increased OSHA penalties. Accessed January 18, 2018. 11. U S Department of Labor. Occupational Safety and Health Administration. NAICS Code: 621210 Offices of Dentists. Accessed January 18, 2018.

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April 2018


Safest Dental Visit


2018 OSAP Dental Infection Control Boot Camp™ Record breaking attendance reveals excitement for dental safety.

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

The multi-day course structure included educational sessions centered munity of clinicians, educators, policy makers, consultants and industry reprearound the principles and theories of sentatives who advocate for the Safest Dental Visit™ – saw record breaking atinfection control on topics such as tendance for the 2018 Dental Infection Control Boot Camp™, held January 8-11, OSHA, exposure risk determination and 2018, in Baltimore, Md. bloodborne pathogens, microbiology and regulatory guidance. The program also highlighted the The OSAP Dental Infection Control Boot Camp™ is a nuts and bolts of day-to-day management, with topics such as foundation-building educational course covering all the basics sterilization and disinfection of patient care items and dental in dental infection prevention and control, as well as patient unit waterlines. and provider safety. This year, over 480 dental infection control The program’s interactive Boots on the Ground sessions personnel from a variety of dental settings attended the course helped to underscore application strategies through demonstraand were provided with resources, checklists and tools adtion and hands-on exercises. Attendees also benefited from a dressing foundational elements of dental infection control and vendor fair featuring over 25 dental infection and prevention safety. Participants also had the opportunity to earn up to 24 companies and organizations, highlighting the latest dental safety hours of CE credit.


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and infection prevention technology, products and services. A distinct feature of the course was the esteemed faculty of infection prevention experts providing detailed lectures, followed by enriching Q & As to address questions and reflect on the dental infection control and prevention topics reviewed. “Providing a crucial resource and outlet for professionals with infection control responsibilities to learn and engage is of utmost importance to OSAP and the Safest Dental Visit™,” says Christina Thomas, executive director of OSAP. “The success and growing interest in the 2018 program would not have been possible without the support of OSAP’s partners, dental infection

“The success and growing interest in the 2018 program would not have been possible without the support of OSAP’s partners, dental infection control advocates, the innovation of our exhibitors and the guidance and expertise of our world class instructors.” – Christina Thomas, executive director of OSAP

control advocates, the innovation of our exhibitors and the guidance and expertise of our world class instructors. We will continue to provide an interactive and vibrant learning environment for course attendees and look forward to future courses.” For attendees looking to take learning to the next level and enhance their knowledge of late-breaking infection prevention and control topics, policy developments and networking, OSAP offers an Annual Infection Control and Prevention Conference, May 31-June 3, 2018 in Dallas, Texas. The conference is richly constructed, combining world class education with valuable networking activities.

The Organization for Safety, Asepsis and Prevention (OSAP) focuses on strategies to improve compliance with safe practices and on building a strong network of recognized infection control experts. OSAP offers an extensive online collection of resources, publications, FAQs, checklists and toolkits that help dental professionals deliver the safest dental visit possible for their patients. Plus, online and live courses help advance the level of knowledge and skill for every member of the dental team. For additional information, visit

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April 2018



Measuring Up Despite a rise in patient visits, dental services account for a small percentage of healthcare spending.

Spending on dental services, while on the rise, still accounts for only

Physician and clinical services (20 percent share). Spending on physi4 percent of U.S. healthcare spending, according to the Centers for Medicare & cian and clinical services increased Medicaid Services. Spending for dental services increased 4.6 percent in 2016 5.4 percent to $664.9 billion in 2016. to $124.4 billion – a slight acceleration from 4.4 percent growth in 2015. Private Although growth for physician and clinihealth insurance, which accounted for 46 percent of dental spending, increased cal services decelerated slightly in 2016 4.8 percent in 2016 – the same rate of growth that occurred in 2015. Out-of-pocket (from 5.9 percent in 2015), it outpaced spending for dental services, which accounted for 40 percent of dental spending, the growth in all other goods and serincreased 4.3 percent in 2016 – a faster growth rate than the 3.4 percent increase vices categories. The growth in the use in 2015. and intensity of physician and clinical services was a driving factor in the overall growth in physician The big picture and clinical services, accounting for nearly three-quarters of Total U.S. healthcare spending increased 4.3 percent to reach $3.3 the 5.4 percent increase. trillion, or $10,348 per person in 2016, according to CMS. Spending growth decelerated in 2016 after the initial impacts of AffordPrescription drugs (10 percent share). Growth in retail preable Care Act coverage expansions and strong retail prescription scription drug spending slowed in 2016, increasing 1.3 percent drug spending growth in 2014 and 2015. The overall share of to $328.6 billion. The slower growth in 2016 follows two years gross domestic product (GDP) related to healthcare spending was of strong growth in 2014 and 2015, – 12.4 percent and 8.9 per17.9 percent in 2016, up from 17.7 percent in 2015. cent, respectively. This strong growth reflected increased spending on new medicines and price growth for existing brand-name Spending by type of service or product in 2016 looked like this: drugs, particularly for drugs used to treat hepatitis C, says CMS. Hospital care (32 percent share). Spending for hospital care Growth slowed in 2016 primarily due to fewer new drug approvincreased 4.7 percent to $1.1 trillion in 2016, slower than the als, slower growth in brand-name drug spending as spending for 5.7 percent growth in 2015. The slower growth in 2016 was hepatitis C drugs declined, and a decline in spending for generic driven by the slower growth in the use and intensity of services, drugs as price growth slowed. reports CMS. Hospital care expenditures showed mixed trends across the major payers, with slower growth in Medicaid and Other professional services (3 percent share). Spending for private health insurance spending, stable growth in Medicare other professional services reached $92.0 billion in 2016, an spending, and faster growth in out-of-pocket spending.


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increase of 4.7 percent. This was a deceleration from the 5.9 percent growth in 2015. Spending in this category includes establishments of independent health practitioners (except physicians and dentists) that primarily provide services such as physical therapy, optometry, podiatry, or chiropractic medicine. Other health, residential, and personal care services (5 percent share). This category includes expenditures for medical services that are generally delivered by providers in non-traditional settings such as schools, community centers, and the workplace; as well as by ambulance providers and residential mental health and substance abuse facilities. Such spending grew 5.3 percent in 2016 to $173.5 billion after increasing 8.7 percent in 2015. The slowdown was driven by the slower growth in Medicaid spending, 57 percent of all spending in this category, which slowed to 5.7 percent in 2016 after 10.8 percent growth in 2015.

was lower than growth in the previous two years when spending increased 4.8 percent in 2015 and 4.9 percent in 2014. The slower growth in 2016 was due to slower growth in spending for both the Medicare fee-for-service (2.2 percent in 2015 to 1.8 percent in 2016) and Medicare Advantage (11.1 percent in 2015 to 7.4 percent in 2016) portions of Medicare. • Medicaid (17 percent share): Total Medicaid spending decelerated in 2016, increasing 3.9 percent to $565.5 billion. This was much slower growth than in the previous two years, when Medicaid spending grew 11.5 percent in 2014 and 9.5 percent in 2015. The

Retail spending for other non-durable medical products, such as over-the-counter medicines, medical instruments, and surgical dressings, grew 4.4 percent (about the rate of growth in 2015, 4.6 percent) to $62.2 billion in 2016.

Nursing care facilities and continuing care retirement communities (5 percent share). Spending for freestanding nursing care facilities and continuing care retirement communities decelerated in 2016, growing 2.9 percent to $162.7 billion, compared to 3.7 percent growth in 2015. The slower growth in 2016 was largely attributed to slower spending growth in both Medicare (1.2 percent in 2016 from 4.0 percent in 2015) and private health insurance (5.9 percent in 2016 from 14.3 percent in 2015).

Durable medical equipment (2 percent share). Retail spending for durable medical equipment, which includes items such as contact lenses, eyeglasses and hearing aids, reached $51.0 billion in 2016 and increased 4.9 percent, which was faster than the 4.1 percent growth in 2015. Other non-durable medical products (2 percent share). Retail spending for other non-durable medical products, such as over-the-counter medicines, medical instruments, and surgical dressings, grew 4.4 percent (about the rate of growth in 2015, 4.6 percent) to $62.2 billion in 2016.

Who’s paying? Meanwhile, CMS reports 2016 spending by major sources of funds: • Medicare (20 percent share): Medicare spending grew 3.6 percent to $672.1 billion in 2016, which

stronger growth in 2014 and 2015 was due in part to the initial impacts of the ACA’s expansion of Medicaid enrollment during that period. State and local Medicaid expenditures grew 3.2 percent, while federal Medicaid expenditures increased 4.4 percent in 2016. • Private health insurance (34 percent share): Private health insurance spending increased 5.1 percent to $1.1 trillion in 2016, which was slower than the 6.9 percent growth in 2015. The deceleration was largely driven by slower enrollment growth in 2016 after two years of robust enrollment growth due in part to ACA coverage expansion. • Out-of-pocket (11 percent share): Out-of-pocket spending grew 3.9 percent in 2016 to $352.5 billion, faster than the growth of 2.8 percent in 2015. This was the fastest rate of growth since 2007 and exceeded the average annual of growth 2.0 percent from 2008-15.

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April 2018



The Changing Face of Endodontics New technology helps endodontists address complex treatments.

Newer technology has enabled general dentists to take on more chal-

microscopes, imaging modalities, efficient files that offer greater resistance for calcifications, anesthetics, educational materials, pre- and postoperative medication, irrigants and ultrasonic tips for extremely calcified canals. Minimally invasive shaping files that can achieve apical enlargement without sacrificing coronal tooth structure are important, as are products that aid in retreatment and/or the removal of gutta percha. With advances in technology, microscopes now provide greater visibility, facilitating increased accuracy. The more efficient models can aid in identifying cracks or fractures, leading to a more precise diagnosis, better treatment and a higher success rate. Imaging techniques have also improved. CBCT imaging, for instance, offers increased diagnostic ability compared to conventional two-dimensional imaging. With CBCT, canals, fractures/cracks and resorption lesions are clearly outlined, enabling endodontists to properly diagnose and treat them.

lenging procedures, leaving endodontists with fewer – and more difficult – patient cases. For distributor sales reps, this is an opportunity to offer their endodontic customers solutions that enable them to practice more efficiently and effectively.

Traditionally, it was the norm for endodontists to receive patient referrals for initial cases, many of which were straightforward and could be diagnosed and treated relatively easily. Today, however, general dentists can – and prefer to – treat many of these cases in-office, leaving endodontists to address the more complex ones, including retreatment, calcified or severely curved canals and cracked teeth. Even with a clinical examination and/or a radiograph, the prognosis is not always clear. The more advanced cases typically involve more post-operative pain and a tenuous success rate, making it difficult to manage patients’ expectations.

New products and technology Endodontists are in need of new products designed to address the complexity of the cases they treat. Their wish list often includes


April 2018

First Impressions

All Sizes Now Available in 21mm and 25mm lengths!

HyFlex® EDM: Stays on Track • Follows the curvature of complex canal anatomy • Offers 700% more fracture resistance than traditional NiTi files* • Simplifies procedures by requiring fewer files • Presterilized *Int Endod J. 2015 May 22. doi: 10.1111/iej.12470

Additionally, with today’s more sophisticated controlled memory files, endodontists are better able to maintain the shape of the canal structure, contributing to more reliable treatment outcomes. For example, pre-bending permits access to more areas than before. Compared with traditional rotary files, which are stiffer, newer files have helped reduce procedural errors, and their wide variety of tapers and tip sizes have enabled clinicians to make apical enlargements. Other new technologies include: • Improvements to apex locators have led to greater confidence in length control. • B etter irrigation techniques, such as acoustic streaming, have led to better treatment outcomes in minimally shaped canals. • New bioceramic sealers are more biocompatible than in the past, leading to advances in bioceramic gutta percha.

Working with your customers Distributor sales reps know their products; endodontists know their specialty. As such, sales reps can approach their endodontist customers by asking a few probing questions: • “Doctor, how can we help make your diagnosis and treatment process more effective and efficient?

• “Have you seen a significant change in the success rate of your procedures when you use certain products?” • “What do you like and dislike about the file you currently use?” One of the first things an endodontist is likely to question is the science behind the rep’s products. Doctors are interested in independent studies (rather than in-house studies) and they look to their sales reps to discuss the science behind their products without rehashing white papers and making a sales pitch. When reps don’t have an immediate answer to a question, a follow-up call is the best approach. Some endodontists, like many dentists, can be resistant to change, and it’s up to the sales rep to show them why it makes sense to try a new product. The dental team may be wary of the learning curve involved in incorporating a new product. Reps can put their customers at ease with a brief five-minute demo that shows the product’s adaptability and ease-of-use. In the end, cost is always a factor for dental customers. Reps can show the practice exactly how much it can save by switching to the new system. A sound investment upfront can lead to a savings in the long run.

Editor’s note: First Impressions would like to thank Coltene for its assistance with this piece.

First Impressions

April 2018



Advances in Endodontics New technology helps endodontists address traditional challenges.

Endodontists, like all dentists, face their share of obstacles when it comes to delivering optimal patient care. Perhaps one of their greatest challenges is providing adequate and predictable chemical disinfection, or irrigation. Additionally, disinfecting the root canal anatomy using instruments and irrigants alone can be tricky. Newer technologies are available today to help endodontists address these and other issues. For example, advancements in rotary file technology have enabled them to use fewer files for each procedure, resulting in decreased contact time with irrigating solutions. And, contact time and solution volume are critical to successful root canal debridement and disinfection. In turn, using fewer irrigants means endodontists must rely on enhanced, faster acting solutions with better penetration capabilities. They also require ultrasonics to propel irrigants into a difficult anatomy and disrupt biofilm through acoustic streaming and cavitation.

Research has shown that ultrasonic devices alone are designed to sufficiently clean a difficult anatomy.

Other new technology designed to help endodontists work more efficiently include: • Enhanced chemistries, which improve the performance of endodontic irrigants. • 2-in-1 irrigants (EDTA/CHX), which simplify the irrigation process and require only two steps. • Cordless ultrasonics, which are easy to use and serve as an adjunct tool to enhance cleansing of difficult anatomy through ultrasonic activation.

Working with the customer With new technologies in their bag designed to help endodontists achieve better patient results, distributor sales reps can provide their customers with optimal solutions. By asking a few probing questions, reps can initiate a discussion and narrow down their customers’ needs: • “Doctor, what is your current irrigation protocol?” • “Are you familiar with the benefits of newer solutions designed to remove guesswork from irrigation?” • “Are you activating your irrigating solutions? If not, are you aware that 35 percent of the canal anatomy is left untouched without the use of ultrasonic activation?”

Endodontists may have reservations about trying new products, particularly if they feel their current irrigation protocol still works. Sales reps should share new research findings with their customers and bring in a manufacturer expert for additional support. This is also an opportunity for sales reps to educate their endodontic customers on the difference between sonic and ultrasonic activation. Ultrasonic devices operate at a much higher frequency (200x higher), resulting in more energy introduced into the canal. Research has shown that ultrasonic devices alone are designed to sufficiently clean a difficult anatomy. By introducing their endodontic customers to the newest solutions available, sales reps can help them make the best investment in their business and offer their patients the highest level of care.

Editor’s note: First Impressions would like to thank Vista Dental for its assistance with this piece.


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First Impressions

Editor’s Note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, First Impressions will profile the latest developments in software and gadgets that reps can use for work and play.


Technology News About a decade ago, when Amazon introduced its first e-reader, publish-

ers panicked that digital books would take over the industry, the way digital transformed the music industry, reports The New York Times. And for a while, that fear seemed totally justified. At one point, the growth trajectory for e-books was more than 1,200 percent. Bookstores suffered, and print sales lagged. But in just the last couple of years, there has been a reversal: Print is holding steady – even increasing – and e-book sales have slipped. One possible reason is that e-book prices have gone up, so in some cases they’re more expensive than a paperback edition. Another possibility is digital fatigue; people spend so much time in front of screens that when they read they want to be offline. Another theory is that some e-book readers have switched to audiobooks, which are easy to play on your smartphone while you’re multitasking.

What’s in store? Western Digital unveiled new devices that address what the company describes as “today’s personal content explosion,” including voice-activated media streaming via popular Smart Home devices, the “world’s smallest” 1TB USB flash drive, and a portfolio of “ultra-mobile, high-performance, wireless and high-capacity flash storage products.” The “world’s smallest 256GB USB flash drive” – the 256GB SanDisk Ultra Fit™ USB 3.1 Flash Drive – can store 14,000 photos, 10 hours of full HD video and 16,000 songs, with 64GB still available for files.

Keep an eye on Fluffy Pebby announced that its smart robotic pet sitter system, said to allow pet owners to monitor, interact with and entertain their pets remotely, was set to ship starting late Q1 2018. The Pebby “ball,” which can be remotely controlled via the Pebby companion app (for iOS and Android), houses a 1080p wide-angle video camera and four lithium-ion batteries to allow pet owners to watch, interact with and capture their pet’s cutest, candid moments in real-time (live footage streams to the Pebby app). Made in a pet-friendly size (80mm in diameter), Pebby features an interchangeable/multi-design

inner casing, built-in LED lights for “night vision” mode and LED glow rims. It also houses built-in speakers and a laser toy that is safe for humans and pets.

Multi-gig connectivity Road warriors with thin, light laptops will be able to experience multi-gig connectivity by using the suite of Thunderbolt™ 3 solutions to multi-gig Ethernet adaptors for PCs and MACs from Aquantia Corp. The Thunderbolt adapters connect to the Thunderbolt port on the laptop to provide an RJ45 Ethernet port that supports 5GbE and 10GbE networks. It is also backwards compatible to support legacy 10/100/1000BASE-T networks.

Free charge

Print is holding steady – even increasing – and e-book sales have slipped.

“Free Wi-Fi” at your favorite coffee shop is great. But how about “Free Charging.” Wi-Charge’s wireless-charging technology uses infrared beams to transfer power between a charging hotspot and client devices within a 10-meter range. The hotspot easily mounts on a wall or ceiling, providing full room coverage, so your cellphone can recharge automatically while you’re drinking your coffee, without any user intervention. Says the company, “Similar concepts have been attempted by others, but so far no one could offer a solution that is powerful enough to charge a phone, have sufficient reach to cover a room, and be radiation-safe. Wi-Charge is the first company to achieve the power/range/ safety level required for a commercial wireless power solution.”

First Impressions

April 2018




The Art – and Science – of Leatherwork Some cook or read to relax. Jorge Rodriguez takes refuge in leatherwork.

“I’ve always been interested in tools and the process of building things,”

As seriously as Rodriguez takes his leatherwork, his craftsmanship is rooted in a somewhat carefree past, he notes. “As a young man, I was sort of a hippie, interested in macramé and making hemp jewelry,” he says. “While in high school, I joined the agriculture program and had a teacher who was interested in horse reins. He owned some pretty intricate reins and asked me for help making a second set.” His teacher put him in touch with an old-school cowboy

says Benco territory rep Jorge Rodriguez. “Leatherwork allows me to create and design, and it definitely requires me to use a lot of tools. “Working with leather allows me to step away from a stressful day and clear my mind,” he continues. “And, I feel a great sense of pride in using and holding something I’ve created.” At the very least, his leather accomplishments have served as a conversation starter with his dental customers, he jokes.


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First Impressions

who, in turn, gave Rodriguez a book on the subject. In time, he became a self-taught leather braider.

A brief change of course Several years later, Rodriguez joined the military. It was a departure from leatherwork, but the experience set him on a new course: servicing dental equipment. “In the army, I worked in the 47th combat support hospital (Ft. Lewis, Washington) as a bio-medical equipment repair specialist,” he recalls. “In that time, I also completed two tours to Iraq (200506 and 2009-10). While working in the hospital, part of my training was in medical and dental equipment. Afterward, my first job was as a field service dental equipment specialist.” Around that time, Rodriguez resumed leather braiding. “Soon after leaving the military, I visited a local leather supply store,” he recalls. “I was purchasing supplies to make a dog collar. The store manager mentioned they offered a leatherwork class. Although I wasn’t interested in the class, I happened to mention that I was a leather braider, which is a rare skill. Indeed, if leatherwork is a dying art, leather braiding is even more rare to come by, he points out. “The manager was excited to hear about my skill and invited me to teach a class,” says Rodriguez. “I’m a showoff and took him up on his offer! And, while there, I began to learn about leather making, as well.”

“Over the years, I’ve had to learn many new skills, from developing a pattern, hand stitching the leather, assembling the parts, finishing the project and, finally, staining and protecting the leather,” says Rodriguez. Even cutting the leather calls for precision, he points out. “Simply cutting the leather can leave rough edges. Instead, you must taper down the edge, folding over the thin part, and glue it down for a nice, finished edge. Similarly, there

A complicated art Rodriguez quickly discovered the complexity of leatherwork. “A friend of mine had built me a custom tool to aid in preparing strings for leather braiding, and I wanted to repay him with a handmade leather tool box,” he explains. It didn’t take him long to discover there’s much more to leatherwork than cutting, stitching and gluing. Each project entails a huge learning curve, he explains. “There are many books available that provide you with a list of materials and step-by-step directions for a specific project. But, you only learn to make that one item. To become an actual craftsman, you must learn what type of leather, tools and stitching are appropriate for a particular project.” There aren’t many books available that cover all of this, he adds.

are many details to keep in mind during the assembly, such as planning around the insertion of rivets, buttons and zippers.” In short, leatherwork requires constant strategizing. If not, “you will run into problems,” he says. “For instance, in the process of stitching the leather, if you exert too much tension when you pull the threads tight, it may distort the leather by compressing and expanding it a bit. A good craftsman will plan around this. Similarly, you need to avoid stitching from the wrong side of the project or making crooked stitch lines, or the end product will be not be aesthetically pleasing. Sometimes, the project requires you to stitch from the middle out – not from left to right.”

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April 2018



Furthermore, the leather required for one project might not be suitable for the next. “The leather you need to complete each project varies,” he says. “To make a bomber jacket versus a saddle versus a wallet is different, because the tanning process is different for each item.” Tanning – or the process of transforming cowhide into leather – can be done a couple of ways, he points out: • Vegetable tanning. Tree bark contains “tannins.” (Hence, the process of turning a hide into leather is called “tanning.”) This method can take several months, depending on the hide. • Chemical tanning. Cowhide can be tanned using chromium salts. The process is faster than vegetable tanning, but vegetable tanning results in a traditional leather smell and patina.


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“Vegetable tanning helps the leather age very well,” says Rodriguez. Some individuals like to combine the processes for the best of both worlds, beginning with chromium salts and later following up with vegetable tanning, he notes. “You want the final project to be aesthetically pleasing and functional,” says Rodriguez. “I’ve invested more time than money in research and self-teaching over the years.”

If the shoe fits Perhaps one of the most challenging leather projects Rodriguez has attempted – and succeeded at – has been shoemaking. Frustrated with always having to compromise between look and fit when searching for a pair of shoes, he finally decided to make his own. “We tend to settle for a look or fit, and we’re not always in love with our shoes,” he says. “I finally researched

how to make my own shoes. Since then, I’ve also made some for family members, including my grandfather, who remembers having his local shoemaker measure and fit him with a pair!” Shoemaking is as much a science as it is an art, notes Rodriguez. “There is some biomechanics involved in shoemaking,” he says points out. “One of the many things you must consider is the height of the heel, which is impacted by a person’s arch and posture. So, because I have high arches, I can’t wear a very high heel. A higher heel puts too much pressure on my back and arches. “You also must consider the instep measurement,” he continues. “This measurement will impact the width of the opening of the shoe – especially with regard to boots, which don’t have laces and can’t be opened up.” Then there is the backside of the heel. “The inner concave profile of the heel is instrumental in keeping a shoe fitted to the foot,” he Rodriguez explains. “You don’t want to have to tie your shoes too tightly or, over time, you’ll cut off your circulation and your feet will suffer.”

Learn to adjust While serving in the military, Benco territory rep Jorge Rodriguez completed two tours in Iraq – first in 2005-06, and later in 2009-10. It was a tumultuous time, and he was never far from danger, yet he doesn’t recall feeling scared. “We certainly had some close calls,” he recalls, noting his first tour was much more active. “We had our shelters and protection, and our hospital was never actually attacked,” he says. “But we did have some close calls, with incoming mortars to our base. And, I did see many casualties. “When you find yourself in such a situation, you adjust,” he continues. “You don’t focus on being scared.”

Leather shoes also require adequate toe spring, notes Rodriguez. “With commercially made shoes, the soles are made of flexible foam or plastic, not leather, enabling the foot to roll from heel to toe. With traditional leather shoes, the toe portion of the shoe must curve up a bit to compensate for the stiffness. So, it’s important to achieve the proper heel height to ensure an adequate toe spring.” That said, the toe spring varies from one style shoe to the next, he adds.

Both sides Since joining Benco four years ago, Rodriguez has had an opportunity to work first as a service technician, and currently as a territory rep in the family-owned company’s Rocky Mountain region. “My background as a service technician definitely helps me better understand the products I sell,” he says. As much as he enjoyed the service side, he has always considered himself “a people person.” So, when a territory rep position became available, he was happy to step in. “While working as a technician, I always admired the territory reps,” he recalls. But, he never realized how challenging their job is, he admits. “Being a territory rep is rewarding and fun. I love visiting my clients. But, if I ever thought this job would be easy, I couldn’t have been more wrong!”

First Impressions

April 2018



Industry News Darby Dental to acquire SmartPractice Dental Supply Division Darby Dental Supply (Jericho, NY) announced its planned acquisition of the dental supply division of SmartPractice (Phoenix, AZ). According to the company, this acquisition will allow Darby to leverage SmartPractice’s acclaimed glove expertise and manufacturing capabilities. SmartPractice’s supply and glove customer base will benefit from Darby’s expansive distribution network, extended product lines, capital equipment, technology services, and equipment service. With this acquisition, Darby will also expand its Chandler, Arizona facility to provide customers with additional services while extending its hours of operation. Additional sales, customer care, and support services will join the Arizona team. The transaction fuels Darby’s growth strategy to extend its ecosystem of full service solutions, while supporting its ongoing West Coast expansion. The transaction is expected to close in May 2018

DHPI makes donation to DLN’s Every Smile Counts Day campaign Dental Health Products Inc (DHPI) (New Franken, WI) committed to donate $2,500 in support of Dental Life Network’s, Every Smiles Counts Day campaign. Dental Life Network (DLN) is a national charitable organization that develops and coordinates collaborative relationships that provide essential resources for direct service programs, especially charitable care, in order to fulfill its mission to

improve oral health of people with disabilities or who are elderly or medically fragile and have no other means of help.

Henry Schein commits $250,000 in healthcare products to America’s Dentists Care Foundation Henry Schein Inc (Melville, NY) announced its commitment to donate up to $250,000 in healthcare products over two years to the America’s Dentists Care Foundation (ADCF) (Wichita, KS). With its two-year ADCF partnership, Henry Schein will donate healthcare product kits valued at $5,000 each, containing gloves, gauze, gowns, and masks. The kits will support the ADCF’s work at up to 50 Mission of Mercy (MOM) dental clinics, which provide free oral healthcare to people living in underserved communities across the U.S.

Patterson Dental signs distribution agreement with Planmeca Patterson Dental, a business unit of Patterson Companies (St. Paul, MN) announced a distribution agreement with Planmeca to distribute the company’s full portfolio of products. Planmeca’s product range covers digital dental units, leading 2D and 3D imaging devices and comprehensive CAD/CAM and software solutions. The Planmeca FIT Open CAD/CAM System featured offerings include the Planmeca Emerald intraoral scanner, the Planmeca PlanMill 40 S, and PlanCAD Easy software.

Henry Schein Appointee Announcements Chris Hollo, Field Sales Consultant Hollo will represent Henry Schein Dental in Milwaukee, WI. He is new to the dental field, and spent the last two years representing Krueger Communications as an Account Executive.


April 2018

First Impressions

Pedrom Tand, Field Sales Consultant Tand will represent Henry Schein in the south Boston area. He is new to the dental field and previously held the role of Financial Analyst for TJX Companies Inc.

Jackie Higdon, Field Sales Consultant Higdon will represent Henry Schein in the Greater St. Louis area. She is new to the dental field and previously worked as an Elementary School Special Education Teacher for Jefferson County Public Schools.

Leo Alvarado, Field Sales Consultant Alvarado will represent Henry Schein Dental in the Albuquerque, NM area. He has 6 years of experience in the dental field all of which he spent working as a sales representative for another distributor.

Rosa Rodriguez, Field Sales Consultant Rodriguez will represent the metro New Jersey region for Henry Schein Dental. Rosa is new to the dental field and previously worked as a sales executive for Marriott International.

Frank Arriaga Jr., Field Sales Consultant Arriaga will represent Henry Schein Dental in the San Antonio, Texas region. Frank previously worked for Vela Dental Centers as an Administrative Assistant for 18 years.

Caleb Costa, Field Sales Consultant Caleb will represent Henry Schein Dental in the Charleston, SC region. He previously worked as a Teacher in the Charleston County School District.

Brady L. Kerkman, Field Sales Consultant Kerkman will represent Henry Schein Dental in the central Nebraska area. He previously held the role of Chief Executive Officer for two years at Choice Family Health Care.

Lisa Spadola, Field Sales Consultant Lisa will represent Henry Schein Dental in the New York City metro area. She is new to the dental field and previously worked as a Pharmaceutical Sales Consultant for Matrix Distributors.

Sherry Presgrove, Field Sales Consultant Presgrove will represent Henry Schein Dental in the Dallas, Texas region. She has over 25 years of experience in the dental field, most of which she spent working as a sales consultant for Premier Dental Products Co.

Jesus Perez, Field Sales Consultant Perez will continue to represent Henry Schein in his new role in the Elmhurst, Illinois area. He previously held the role of Service Technician for Henry Schein. Matthew Chernego, Digital Technology Specialist Chernego will continue to represent Henry Schein Dental in the New Jersey metro area. He holds a Bachelor’s degree in professional sales, and worked as a Field Sales Consultant for Henry Schein for more than a year. Nick Hall, Digital Technology Specialist In his new role, Hall will continue to work for Henry Schein in the Charlotte, NC region. He has held various positions with Henry Schein for eight years. Frank Chambers, Digital Technology Specialist Chambers will be based in the Chicago, IL in his new role for Henry Schein Dental. He’s been with Henry Schein for three years, during which time he worked as an Equipment Product Specialist. Adam Dunn, Digital Technology Specialist Dunn will be based in the Columbus, OH region for Henry Schein Dental. He is new to the dental field and previously worked as a Senior Sales Representative for Shire Pharmaceuticals and Shionogi Pharma. Kristen Meinke, Field Sales Consultant Meinke will represent Henry Schein in the Birmingham, AL region. She previously worked for Solutionreach as a territory sales representative, and has been in the dental field for more than two years. She has a Bachelor’s degree in Biomedical Sciences from Auburn University. Jennifer Maxwell, Field Sales Consultant Maxwell will represent Henry Schein in the Philadelphia and Delaware County regions. She previously worked as a client solutions manager for four years at Envision Pharma Group. She has a Bachelor’s degree in Communication Studies from Westchester University.

First Impressions

April 2018



Patterson Appointee Announcements Gabriela Almaraz

Mashall Baker

Danielle Beverly

Lonella Brechner

Mark Bryant

Tatyana Carey

Jason Durham

Matthew Edmonds

Andrea Felix

Elly Gaffud

Evan Kolkebeck

Kamil Mankarious

Linda Okwor

Alex Perreira

Chris Shad

Stephanie Stephens 54

April 2018

First Impressions

Paul Volk

Lindsey Walker

Ryan Zimney

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Dr. Papathanasiou chose Tetric EvoCeram to close the diastemas between the six anterior teeth. The use of Tetric EvoCeram enamel and dentin shades gave excellent long-term esthetic clinical results.



Fi april18  
Fi april18