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

For Dental Sales Professionals

February 2018

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Solutions Spotlight New products and services for your dental practice customers

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February 2018


Publisher’s Letter Off and Running


Nitrous Oxide and Oxygen Sedation

More dentists are finding that nitrous oxide leads to enhanced patient satisfaction, efficiency and revenues.

Piped vs. Portables

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

From small, informal gatherings to an online community of new dentists and students, Dr. David Rice continues to give back to the dental industry.


Ask the Expert

A former practicing dentist and current sales expert answers your questions

2018: A look ahead

OSAP: An education resource for you and your dental infection control audience

Industry experts discuss changes we can expect to see in 2018.

Training opportunities, resources, compliance checklists and toolkits


Pain Management

Improved technology and delivery systems have made it easier for dentists to keep patients comfortable and calm

Respiratory hygiene and cough etiquette in the dental practice Quickbytes

Technology News

A career in the Air Force prepared Chris Jablonski to address challenges, both personal and in the dental practice.



First Impressions

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BILL NEUMANN Editorial Staff

Off and Running This is my first Publisher’s Letter of the new year,

and I’d like to highlight some of the important changes that will influence our industry in 2018. These changes will impact the companies we work for, the dental practices we support, and the patients that are served by our customers. On December 20, 2017, the House and Senate passed the Tax Cuts and Jobs Act, legislation that makes significant changes to the tax code. The American Dental Association advocated on behalf of dentists to ensure that tax provisions that would benefit dentists were considered when crafting the tax bill. The ADA highlighted provisions in the Tax Cuts and Jobs Act that they believe will positively impact our customers. These beneficial provisions are: • Bettering the cash flow accounting allowance. • Improving Section 179 deductions from $500,000 to $1 million and expanding what property qualifies for this deduction. • Keeping student loan deductions at current levels. • Instituting a new deduction for all pass-through entities. This includes S corps and sole proprietorships. This deduction would now cover some professional service businesses, including dental practices. *

Additionally, a resolution was signed which provides for a two-year suspension of the medical device tax. The tax is suspended until the end of 2019. This will directly impact many of the companies that First Impressions readers work for. Also included is a six-year extension of the Children’s Health Insurance Program [CHIP]. CHIP provides dental care for 9 million children.** Many positive things have been set in motion for the dental industry to have a very strong year. Let’s make our customers aware of this good news and make sure they are taking full advantage of the new tax benefits. The combination of favorable tax reform for our customers and the suspension of the medical device tax should give you all the encouragement you need to make 2018 your most successful year yet. All the best in 2018,

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 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 Bill Neumann *, **


February 2018

First Impressions

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



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

When patients enter into treatment feeling comfortable, relaxed and

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


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The science behind the technology Enhancements in technology have made it increasingly safer and more efficient for dentists to administer nitrous oxide. Nitrous oxide/oxygen flowmeters have traditionally relied on needle valves and glass tubes to control the flow of gas, according to Keefer. Today’s systems feature flat screen displays; digital, touch pad controls that offer greater accuracy over longer time frames; and enhancements in infection control. As such, it’s important for clinicians to stay up-to-date and educated about the process.

Nitrous oxide continues to be administered by inhalation, absorbed by diffusion through the lungs and eliminated via respiration, she notes. Proper equipment for monitoring, and storage

unit integrity, are necessary in order to avoid unintended gas leakage or excessive exposure. In addition, clinicians should be educated on the various components of a nitrous oxide/oxygen sedation system: •N  itrous oxide is stored in closed gas cylinders. Oxygen and nitrous oxide are part of the required equipment. • R egulators ensure safe delivery of gas to the patient by reducing/controlling the pressure from the cylinders. •M  anifolds in a central delivery system connect several large cylinders of gas together, ensuring the constant availability of gas to each treatment room through copper lines within the walls of the building. • In a portable system, a yoke stand is the metal framework on which the equipment rests and is easily moved on wheels to different areas of the dental office. • F lowmeters are highly calibrated devices designed to indicate the amount of gas being delivered to the patient. Flowmeters further reduce the pressure level to local atmospheric pressure, and restrict the proportion as well as the flow rate of nitrous oxide with a fail-safe mechanism to keep a minimum oxygen concentration of 30 percent. • The reservoir bag contains the gas mixture being delivered to the patient. • Gas is delivered through conduction tubing, which runs from the delivery unit and attaches to the breathing apparatus. • The capnography device monitors patient breathing by measuring the actual CO2 in the patient’s exhalation. • A specially designed nasal mask/hood fits snugly around – and fully covers – the patient’s nose, allowing the mixture of nitrous oxide with oxygen to flow, while providing complete access to the patient’s mouth. Single-use, disposable masks are preferred to reduce the spread of infection. Disposable masks today are available in various designs and sizes, as well as patient-friendly scents like vanilla, strawberry, mint, grape, and bubblegum. Newer low-profile masks provide unencumbered access, with a small lightweight scavenging system, which is easier to work around than the traditional masks and hoses. This contributes to more efficient care and reduced chair time. While traditional masks are opaque, some newer nasal hoods are translucent, allowing clinicians to visually monitor their patient’s breathing.

Resolution 37 In October 2016, the passing of Resolution 37 at the American Dental Association’s (ADA) annual meeting called for revisions to

safety regulations for providing anesthesia and sedation, according to Keefer. The rules and regulations for nitrous oxide sedation largely remain the same in light of Resolution 37, she explains. “Healthcare providers are required to complete 14 hours of CE for N2O/O2 alone and 16 hours for N2O/O2 combined with a single-dose sedative up to the MRD. MRD is maximum FDArecommended dose of a drug for unmonitored home use. “Sedation levels deeper than what are typically found with nitrous oxide (minimal sedation) now require considerably more training than in the past,” she continues. “Performing oral, intravenous or any other method of moderate sedation now requires a 60hour course and at least 20 patients. Previously, only a 24-hour, 10-patient course was needed. Dentists who were already practicing sedation dentistry before the guidelines [were issued] are now required to be re-trained and will not be grandfathered in as in the past. Critics of the resolution cite the financial impact of the new regulation, as the increased training will drive costs up, preventing dentists from pursuing advanced sedation training. “Resolution 37 is only a guideline and the ADA has no enforcement authority,” Keffer explains. However, most state dental boards will adapt the ADA guidelines in drafting their own regulations. “Dentists offering sedation can vastly expand the scope of their practice,” she says. “Yet, probably fewer general dentists will elect to go through the trouble and expense to get their moderate sedation certification. Following the dramatic increase in training required for deeper states of sedation, many will limit their practice to nitrous oxide, with or without a singledose oral sedative up to the MRD.”

Newer low-profile masks provide unencumbered access, with a small lightweight scavenging system, which is easier to work around than the traditional masks and hoses. This contributes to more efficient care and reduced chair time.

Regular service, enhanced safety and longer life expectancy It is important for dental offices to have their nitrous oxide and sedation equipment serviced and calibrated at a minimum every two years, notes Keefer. Doing so can help avoid the potential for leakage and ensure the equipment is safe to use, as well

First Impressions

February 2018



as ensure it runs efficiently for 15-20 years. “Manufacturers recommend various levels of maintenance and service for their units, including routine, preventive, scheduled and recalibration,” she says. In addition to recalibration, service protocols should include pressure testing and internal component integrity/replacement, as well as any other necessary factory testing procedures. Clinicians should refer to the specific manufacturer’s IFU (Instructions For Use) and follow the recommendations to ensure safe use and delivery of NO2/O2 for patients and staff. The service and inspection of anesthetic gas equipment should be performed by qualified service personnel.”

There are two options for delivering nitrous oxide, notes Keefer: portable units and central systems. “Portable – or selfcontained units – can cost between $3,500 for a two-cylinder system to $8,000 for a four-cylinder, enclosed system,” she says, noting that portable systems are recommended for offices that only occasionally use nitrous oxide/oxygen sedation. The cost of centrally installed systems – which are recommended for practices that routinely implement nitrous oxide/ oxygen sedation – ranges from $2,500 to $4,000 per operatory, with a total average cost of $28,000 for a mid-sized office, notes Keefer. “Although the initial set-up costs are high, the central

An investment for the practice Implementing nitrous oxide/oxygen sedation in a dental practice – no matter how small or large – can quickly become a source of revenue, as well as help the practice address the needs of patients anxious about their pain management. (The current ADA/ CDT-4 code for billing dental procedures using nitrous oxide/ oxygen sedation is 09230.)

A conversation starter Sales reps can initiate a discussion about nitrous oxide with their dental customers by asking a few probing questions: • “Doctor, do you currently offer N2O/O2 sedation?” • “If not, can you tell me why?” • “If so, how often is it used per week?” • “Do you charge a fee?” • “Do you consider your patients’ comfort levels valuable?” • “Are you less stressed when your patients are relaxed and cooperative?” • “Are you aware that by implementing nitrous oxide at your practice, you can potentially generate about a $30,000 profit annually, simply by using it just 3-4 times each day?” • “Have you considered the number of potential new patients who might call your practice to inquire whether you offer nitrous oxide/oxygen sedation, and how many might not schedule an appointment if you do not offer it?” • “Have you seen the Digital Ultra Flushmount Flowmeter by Crosstex/Accutron?” • “Have you seen the new Crosstex/Accutron Axess LOW PROFILE Nasal Mask?”


February 2018

First Impressions

Indeed, when a dental practice considers that the use of nitrous oxide/oxygen sedation systems helps patients relax in the chair – thereby reducing patient chair time and increasing office efficiency – and leads to greater revenue, most clinicians will agree it’s a worthwhile investment. system is more cost-effective in the long run,” she points out. “The smaller E cylinders of a portable system are approximately five times more expensive than the larger G or H cylinders, due to the high cost of packaging the gases. In addition, the centralized system is more convenient, as it minimizes the need to change cylinders frequently. Not only are the cylinders larger than those of a portable system, several cylinders can be connected via a manifold system. When one cylinder is depleted, the system automatically switches to the next available cylinder.” Indeed, when a dental practice considers that the use of nitrous oxide/oxygen sedation systems helps patients relax in the chair – thereby reducing patient chair time and increasing office efficiency – and leads to greater revenue, most clinicians will agree it’s a worthwhile investment. At the end of the day, satisfied patients mean more return visits, more patient referrals and a greater bond with the community.

Piped vs. Portables Piped nitrous oxide systems often offer the best solution – provided they are properly installed. BY LAURA THILL

More and more dental offices rely on nitrous oxide/oxygen sedation to reduce patients’ anxiety and help them relax during complex dental procedures. For offices that use nitrous oxide/oxygen sedation even a few times each week, piped – or plumbed – systems could offer the most efficient and economical solution. Although there is an upfront cost for piping a nitrous oxide/oxygen sedation system (i.e., the cost of a medical gas plumber, copper piping, a manifold system, zone valve emergency shut off systems, if required, and a verification/inspection fee), there are long-term cost savings and benefits of which some clinicians might not be aware, notes Michael Civitello, sales manager, Porter Instrument. “It makes sense for dentists to sit down and evaluate the long-term benefits before making a decision that they may later regret,” he points out.

In some cases, portable e-cylinder carts continue to offer a viable solution, he continues. He recommends portable systems when: • The dental office is already built, and there are no options for running piping through a drop ceiling or basement. • The current dental owner will only be at that location for a couple of more years, after which he/she plans to build a new office or stay on as an associate. • The office has no plans to incorporate nitrous oxide/oxygen sedation into its regular routine, and only expects to use it a few times each year.

First Impressions

February 2018



For dental offices looking to offer nitrous oxide/oxygen sedation more routinely, however, there are a number of benefits to adding piped or plumbed nitrous oxide systems, says Civitello, including: • The cost of gas from larger H/G type cylinders compared with E size can easily equate to a $10 savings per patient on the gas itself. “Multiply that times the number of uses per week, and calculate that out over five, 10 or 20 years. It’s a large expense.” • P ortable e-cylinder systems may seem like a good idea, but compared to a centrally plumbed system, many dentists (as well as assistants) often find reasons to not use them. Portable systems are never ready for use;

The cost of gas from larger H/G type cylinders compared with E size can easily equate to a $10 savings per patient on the gas itself. “Multiply that times the number of uses per week, and calculate that out over five, 10 or 20 years. It’s a large expense.” often are located in another room; require a constant change of cylinders; and take up valuable floor space. In addition, the cylinders generally arrive from the gas suppliers dirty and rusty, and they will be in plain sight of their patients. • With a central system, every operatory is ready for nitrous use. Having operatories set up for all types of uses helps avoid situations where one case may run long and the office must move a scheduled patient to another operatory, where nitrous may not be available. “Dentists don’t want to be in a position where they are unable to provide nitrous to patients who want or need it.” • If nitrous oxide/oxygen sedation is easier to use, it will be used more often. “The whole reason to have a


February 2018

First Impressions

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

Rely on the experts Manufacturer equipment specialists can ensure that piped nitrous oxide systems are installed correctly and safely, and dentists and their sales reps should involve their nitrous equipment manufacturer representative early in the process,

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notes Civitello. “There are many flowmeter options from which dentists can choose, as well as several installation options,” he points out. Once the needs of the practice and the design of its operatories are clear, the manufacturer rep/equipment specialist can recommend the best possible solutions, as well as advise on what is required from a code perspective. “Many Porter representatives have an ASSE 6005 Medical Gas System Generalist certification, which is essentially the same course that a Certified Medical Gas Plumber takes (without the hands-on/brazing portion).”

• Detached tank room. When the tank room is detached from the main office, both an automatic changeover manifold and zone valve will be required. An example of this would be a tank room in the basement or in a storage room located outside the main building (with no internal door from the main office to access). Dentists should consider installing an automatic changeover manifold, rather than a manual changeover manifold, notes Civitello. “The manual changeover manifold may appear to save them some money,” he says. But, with this option, when the cylinder is empty, someone must go to the tank room to close one cylinder and open another, wasting time. It can be disruptive to a patient’s procedure and inevitably lose the practice money. “With an auto-changeover manifold, when one cylinder runs low, it automatically switches to a full cylinder,” he says. “There is no disruption in the patient procedure, nor does anyone have to go to the tank room.” An experienced manufacturer rep can also ensure that the piped nitrous oxide system is installed by a properly certified plumber, and inspected by an independent third party, Civitello continues. “It’s important that only a certified medical gas plumber works on the piping system,” he says. “These plumbers have an ASSE 6010 certification. They are required to carry an identification card at all times and are the only ones allowed to handle the piping and installation.” In fact, they can’t have an apprentice assist them unless that individual is ASSE 6010 certified, he points out. “Dentists and/or general contractors absolutely should not hire Joe the plumber who is trained to fix toilets. This is where major mistakes can happen, and it can cost patients their life.” The piping system must be inspected by an independent verifier, notes Civitello. “This cannot be the person who did the installation, and he or she must have an ASSE 6030 medical gas system verifier certification. Dentists and/or general contractors cannot skip the verification to save $1,000. This is required.” Installation is not complete until both the medical gas plumber and medical gas verifier have conducted all required safety and functional tests, including the crossed lines test, he adds. “In the end, these documents must be turned over to the dentist.”

The cost of gas from larger H/G type cylinders compared with E size can easily equate to a $10 savings per patient on the gas itself. “Multiply that times the number of uses per week, and calculate that out over five, 10 or 20 years. It’s a large expense.” Equipment specialists can work with a dental office to address a number of important points, including: • F lush mount flowmeters. It’s important to consider the style and type of cabinetry in which the flowmeter will be installed, as not all flowmeters fit in all cabinets. The manufacturers rep can advise which flowmeter will work best in each cabinet style, and how best to position the flowmeter. •O  utlet stations. If using outlet stations, it is critical to plan where the outlets will be located. Installing outlets on the wrong side of the room can be a disaster. • Piping. It is essential to pipe all operatories, even if they are not being set up with a flowmeter. Non-functional operatories can be piped, with a termination-point shut-off valve installed. If at some point the practice wishes to expand, the piping is in the wall; it will be easy to access the piping and connect a flowmeter. (If an operatory is not piped, and the office decides to expand, it must bring in a medical gas plumber to cut pipes, rip open walls, etc.)


February 2018

First Impressions



Q: H ow can I get dentists to listen, become more interested, and respond better to me when speaking to them? Editor’s note: Anthony Stefanou, DMD, will answer reps’ questions on their dental customers. Email him your questions at or visit


Ah, the magic question. In addition to sales training, I offer several programs within dental, including business development, recruiting, and M&A services. I receive, on average, 7+ calls a week from leaders/executives of companies, everything from startups to large corporations. In many cases, the caller starts by telling me about his/her company, then proceeds to ask me some general questions, and finishes by negotiating the fees for those services being inquired about. While it’s potential business, I don’t get overly excited early in the conversation, because I may have a shopper on my hands.

This past week, however, I received two phone calls which immediately got my attention. Within the first 30 seconds, the leaders made it clear that they had researched me thoroughly before they picked up the phone. They reviewed my LinkedIn profile, read business articles I wrote and posted online, and checked out my websites. Then, the callers asked specific, open-ended questions. They told me they weren’t looking to waste time and were willing to spend what was necessary to work together if the result of the conversation was that we were compatible. Within a minute or two, I was completely engaged and excited about the possibilities of working with the callers. Why am I telling you this? The majority of dental sales reps I work with are professional and knowledgeable about their products, services, and/or companies. Once you have a decisionmaker’s attention, you want to maximize your time. While it is tempting to try to get right to it, it is crucial that you first do your homework before your conversation, enough that it’s evident to the person you are speaking with.

First Impressions

February 2018


ASK THE EXPERT Too often in the first conversation with an office manager or dentist, what I see and hear are one or a combination of the following: • The impress approach. The rep goes straight to several minutes of telling. “Here’s what we have, here’s why it’s the best, here’s why you need it.” Then, the rep proceeds to read the product sheet. This approach is designed to let reps brag about all the things they do, and see what sticks. • The price approach. The rep goes right to specials or pricing. • T he ask-the-easy question approach. The rep starts by asking “Tell me about your practice?”

Dentists expect you to be knowledgeable about what you sell, and they expect you to say you are the best. Your competitor did the same thing. Besides, rattling off the product sheet rarely works, because often much of what is on that list the dentist already has or is doing, so by the time you get to the possible one feature/ benefit that he/she does want, they have almost turned off their listening. Plus, they will believe your pitch doesn’t differ from dentist to dentist, and they believe they are different from the dentist down the street. There are better ways to get them to acknowledge what you have that is of interest.

So, what’s the problem?


The missing piece Going back to the example I gave of my experiences being called on recently, the missing piece is preparation. When you ask a dentist to describe their practice, it is often interpreted by the dentist as lazy, or too broad/general. Plus, dentists get asked that same question by many. Thus, you aren’t differentiating yourself from the rep who called on them yesterday. With pricing, if you ask because you can offer a great deal, I understand why it’s tempting to go that route. Everyone wants a good deal. The problem with this approach is that dentists are usually still not going to buy until they know how/why your product or company fits into their practice and their current active patient base. My surveys show that price is second or third most important when deciding on whether to do business with a rep or a company. Lastly, it’s great that you are knowledgeable and even passionate about what you sell, so spewing information is nice to be able to validate that, but again, most of what you are saying is not heard when you are doing this approach.

Spend a few minutes googling the office/dentist. Visit the website. What can you pick up about the doctor? Years practicing, awards, articles they’ve written, hobbies?


February 2018

First Impressions

Let’s go back to the actual question asked at the top of this column – how do you get the dentist engaged in the conversation? Prepare. Spend a few minutes googling the office/dentist. Visit the website. What can you pick up about the doctor? Years practicing, awards, articles they’ve written, hobbies? Do they have hygienists? If so, how many, and what are their names? Do they have an office manager? What kind of procedures/programs do they offer? What kind of patients do they treat? Even if they are already an account, it may be some time since you’ve worked with them – what else is new in their practice? Start your conversation with a statement: “Dr. Smith, I noticed your practice…” This tells your customer you know who they are and aren’t robotic in your approach, and it allows you to get more specific with your questions rather than asking them to tell you about themselves. Finally, it gets the dentist talking early in the conversation. Reps often tell me they do this. However, I can tell you from experience that while that may be the case sometimes, it’s not all the time, and it should be. I hear excuses like: “I don’t have the time, they’ll tell me what I need to know,” or “my job is to tell them about my special.” Yet everyone tells me they aren’t getting enough new business/accounts. Making the commitment to do this one tweak in your initial conversation will be the difference. I’ve been doing surveys with my colleagues for 20+ years. The No. 1 reason, every year for 20 years, that they work with reps and companies is because the reps sincerely show interest in their practice. Yes, even if the price isn’t the lowest. Also, dentists know whether they will do business with someone by the end of the second conversation. Dentists may not buy after the second conversation if it’s yes, it just means they know. You want to get to the second conversation and show them you care and let them talk. You want to impress? You want them to listen? You want them to be interested? Show them you’ve done your homework!

Safest Dental Visit


OSAP: An education resource for you and your dental infection control audience Training opportunities, resources, compliance checklists and toolkits Editor’s note: Understanding OSAP’s educational training opportunities, complimentary resources and membership benefits provides the advantage to educate yourself and your dental customers, and connect them with their patients.

The Organization for Safety, Asepsis and Prevention (OSAP) is a community of clinicians, educators, researchers and industry representatives who advocate for safe and infection-free delivery of oral healthcare. Focusing on strategies to improve compliance with safe dental practices and building a strong network of recognized infection control experts, OSAP serves as a leading provider of education to support safe dental visits and encourages you take advantage of the education tools. Resources available to you now OSAP offers an extensive online collection of resources, publications, FAQs, checklists and toolkits that help dental professionals deliver The Safest Dental VisitTM possible for their patients. An example of curated information available to you now on is the OSHA Hazard Communications Standard Update: • View the OSHA Hazard Communications Standard Update. • Easily access a review of the key learnings for reference. • Find related articles, videos and FAQs.

Safety and the role of the infection control coordinator Did you know that while safety is the responsibility of everyone in the dental industry and community, the CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care Guidelines recommends having a written infection control program, evaluations, documentation and ongoing training on safety topics? To provide oversight of this program, it is also recommended that practices and organizations have an infection control coordinator (ICC). Often, these responsibilities are found in the existing job titles of your consumers including, dental assistants, office managers, OSHA coordinators, safety directors, etc. This means that in addition to their established

job duties, your consumers must also have the knowledge, resources and time to successfully coordinate and provide accountability to the program, including product evaluation and selection. OSAP supports the duties of the ICC through comprehensive safety education resources and public campaigns, including Dental Infection Control Awareness Month.

Direct connection to decision and policy makers OSAP offers online and in-person education to help advance the level of knowledge and skill for every member of your team and the dental community. For example, hundreds of clinicians, educators, consultants, policymakers, industry representatives and ICC’s attended the 2017 OSAP Dental Infection Control Conference. On the cutting edge of dental infection prevention and safety education, attendees participated in sessions with infection control thought leaders and listened to presentations direct from CDC, FDA, OSHA officials, and other government agencies. The conference also serves as an important networking opportunity in dentistry with the latest products and innovations on display from exhibitors and sponsors. OSAP encourages you to attend the 2018 Dental Infection Control Conference in Dallas, Texas on May 31 - June 3, 2018. More information is available on the OSAP website, There are multiple ways for companies, exhibitors, and sponsors to get involved and partner with OSAP through corporate membership, attending events, and various sponsorships. To learn more about how OSAP is the education resource for you and your consumers, visit

First Impressions

February 2018




Dedicated Sales Team Provides Great Customer Service Air Techniques is looking forward to a year of growth through their best-

in-class sales organization. The company is excited to serve you with their brand new sales team, as it best prepares for the future and further provides its dealer partners and dental professionals with the best customer service. The company has dedicated resources to ensure that you receive the attention you deserve. They understand the importance of relationships so much they have expanded their sales team in a really big way. Air Techniques has your back with its exclusive sales team, which has more than doubled the company’s selling manpower. Its new field sales team in North America is comprised of 31 elite sales professionals, including 26 Territory Managers who report to

4 Regional Sales Managers and a Director of Sales. At the same time, its Special Markets sales team has doubled its capacity with a Director of Special Markets and 3 Special Markets Sales Managers. Additionally, its Monarch Infection Prevention sales team has grown to 2 Monarch Sales Specialists led by a Monarch National Sales Manager.

Refer to the perforated insert on the next page to see the faces and contact information for the entire Air Techniques North American Sales Team. Every one of the new sales hires has dental sales experience so they are attuned to the needs of dealer partners and dental professionals. They understand the importance of personal service to ensure individual needs are met. Collectively, Air Techniques’ new sales team has over 600 years of progressive dental experience. The key to great customer service is responsiveness. When you need your Air Techniques sales professional, he or she will be there for you. Together, the future is ours.


February 2018

First Impressions

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From small, informal gatherings to an online community of new dentists and students, Dr. David Rice continues to give back to the dental industry. David Rice

In his 11 years teaching at the State University of New York at Buffalo dental school, David Rice, DDS, especially enjoyed the small-group discussions that took place after class. In time, the handful of students that routinely gathered after class to follow up with questions evolved. “After a while, I began inviting these hungry students to lunch,” he recalls. In turn, the students invited their friends to join in and, in no time, the intimate group had grown substantially. “Within a few months, I found myself hosting 200 students for dinner!” It came to him, then: “I love doing this. Why limit this to one dental school?” Within a year, Rice had founded igniteDDS, an online student and new dentist community, and was hosting seminars across the country, from New York and Pennsylvania to Florida and Texas. “I spent over $70,000 in the first two years, and my friends in business thought I was crazy,” he admits. “But, I figured my worst case scenario would be to pay it forward.”


February 2018

First Impressions

“We need to stay focused and bring solutions to the everyday problems our profession faces.” – David Rice, DDS, Founder igniteDDS

As it turned out, he had little to worry about. “We quickly adopted social media, enabling us to leverage live events, webinars, online speakers and more. From there, we grew exponentially.” That’s not to say the early years were easy, Rice continues. “In the beginning the industry didn’t see the value,” he says. “They couldn’t get past the lack of immediate return on investment. The upside was, as time went on, ignite’s culture and vision became crystal clear to many on the industry side.” Six years later, igniteDDS has matured into an online educational movement of students, new dentists and seasoned professionals who are looking to share – or gain – real world practice management and clinical advice and expertise.

An industry jumpstart

Four generations

Today, igniteDDS works with “a constant stream of dentists who are looking to give back to the community,” Rice says. “These are industry experts who want to be involved and engaged with our online audience of students,” he explains. In addition, igniteDDS includes a team of student leaders from 40 dental schools. At press time, Rice expected to add another 15 student leaders, representing a total of 65 dental schools, by the start of 2018. “Our student leaders beta test our outreach and online programs, etc.,” he says. “Our ability to stay ahead of the curve is key and our core team is incredible at helping us make that happen.” As a result, he has revised his website six times within as many years. “We get our website in front of these dental students, who can share their input – input we use to further develop our website.” Although the educational content and focus has been fluid, his mission has remained unchanged, – David Rice, DDS, notes Rice. “We’ve stuck Founder igniteDDS to our original mission to provide the next generation of dentistry a 10-year jumpstart on their success,” he says. “Through igniteDDS, we educate them and connect them with the right industry people. Whereas it may have taken me about 10 years to make the right connections, I’d like to see this generation of dentists do so immediately. “Dental school tends to involve a decade of learning crammed into four years,” he continues. “It’s the nature of the beast.” But, given the enormous debt students graduate with, it’s important that they break into the industry as quickly as possible, he adds.

In part, the success of igniteDDS is due to Rice’s ability to recognize – and address – the dental industry’s changing demographics. “For the first time, we have four generations practicing dentistry,” he says. And, for the most part, “dentists do what they do very well – but within their own space,” he points out. “Through igniteDDS, we work to bring them together. “It’s always been our goal to define the millennial dentists to the more seasoned ones, who often seek new dentists who might be interested in acquiring their practice. These dentists want – and need – to understand the millennials.” And while it’s sometimes a challenge to help close the gap between young and old professionals, igniteDDS has successfully stayed its course and stuck to its mission, Rice notes. “We’ve always known that to be successful, we need to dig deep, rather than

“We’ve stuck to our original mission to provide the next generation of dentistry a 10-year jumpstart on their success.”

What is igniteDDS? igniteDDS is an online community of students, new dentists and seasoned professionals. Successful dentists share real-world advice on practice management to guide others looking to grow their practice or become first-time owners. Members have access to guided videos, job opportunities, blogs, educational resources and more. For more information visit

dig wide,” he says. “We need to stay focused and bring solutions to the everyday problems our profession faces.” Looking ahead, Rice anticipates expanding the igniteDDS offerings to include the entire dental team. “Currently, we are focused on the dentists and their pathway,” he says. However, a year ago, drawing from the expertise of professionals, his organization launched igniteDA, a program for dental assistants. Over the next few years, he would like to unite the whole dental office in one arena, while enabling each team member to focus on his or her own responsibilities, he adds. In addressing the needs of the entire dental team, Rice looks to embrace a model of growth. Particularly as dental practices expand and more DSOs emerge, “our job shouldn’t be to isolate one area or model of dentistry over another,” he points out. “We offer a course called Pathway to Process, designed to educate and inform our community about the various practice models – their advantages and limitations. We want our students not only to stay current, but to always remain ahead of the curve.”

First Impressions

February 2018


Solutions Spotlight

First Impressions asked a handful of manufacturers about new products and services in 2018 that will help dental practices flourish. Here are their responses.


February 2018

First Impressions

Cranberry Editor’s note: Sponsored by Cranberry.

The fit of

a face mask is integral to its effectiveness and the protection it provides. An ill-fitting mask increases the exposure to airborne bacteria, ultimately leading to contamination. A pleated face mask – the most popular design in dental – exposes gaps areas around the sides and bottom chin of the face due to its standard size and shape. Cranberry’s new 360 Face Masks feature an exclusive 3D design for complete coverage and protection. The mask forms a V-shape, which prevents collapse, and the sides of the mask are designed with curved edges that allow the mask to lay flat against the skin, removing gaps commonly found with pleated masks. In addition, an anti-fog cushion is built into the top of the mask to reduce fogging to the practitioner’s eyewear and aids in absorbing sweat and moisture buildup on the bridge of the nose.

Reducing the gapping of the practitioner’s mask increases the overall effectiveness of infection control in the operatory, thereby protecting the health of both the practitioner and the patient. Distributor sales reps can initiate a discussion with their dental customers by asking:

• “Doctor, are you experiencing any gapping issues with your current procedural face masks?” • “Are you experiencing fogging issues with your current face masks?”

Practitioners may be skeptical about the unique design of Cranberry’s 360 Face Masks. But, they can rest assured that the design serves a purpose by creating a complete 360-degree seal of protection. To ensure a consistently low price, Cranberry has bundled the boxes with 40 masks per box and will support introductory promotions to encourage practitioners to try the 360 Face Masks. 360 Face Masks are available in ASTM Level 2 and 3, and in two sizes – small and regular – to conform to different face shapes.

First Impressions

February 2018



Ansell Editor’s note: Sponsored by Ansell.

Ansell, a global leader in protection solutions and makers of the popular Microflex® and MICROTOUCH® examination gloves, is excited to announce the launch of its MICROTOUCH® DENTA-GLOVE® SERIES, a highly diversified portfolio of dental examination gloves that simply outperform the competition. 24

February 2018

First Impressions

MICRO-TOUCH DENTA-GLOVE is the first series of examination gloves developed specifically for the needs of dental professionals. All products in this series are certified for use in oral examinations for patient safety and peace of mind and are designed with the most advanced film technologies to meet the unique and demanding needs of the dental profession. Products are tested for bio-compatibility and some feature inner coatings to promote hand health. For more information about MICRO-TOUCH DENTA-GLOVE examination gloves or to request a free sample visit


Hu-Friedy Editor’s note: Sponsored by Hu-Friedy.

Dental practices face unique challenges and need product solutions

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

IMS makes it easy for consistent training in all practice locations. With the time savings gained, offices have additional time to see more patients and spend on more value-added activities in the dental practice. 26

February 2018

First Impressions

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

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

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



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





Crosstex / Accutron™ Capnography Adapters for Use with N2O/O2 Sedation ®

Editor’s note: Sponsored by Crosstex®/Accutron™.

Capnography – a patient safety feature designed to monitor breathing – is

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

Introducing Axess™ Capnography Adapters Crosstex®/Accutron™, manufacturer of the Axess nitrous oxide/oxygen sedation product line, has recently expanded its offerings to include Axess™ Capnography Adapters. The new capnography adapters complete the Axess product line, which includes low-profile, single-use translucent nasal masks and scavenging circuits. The adapters provide a CO2 capnograph monitor sample line connection for the purpose of monitoring patient end-tidal carbon dioxide (EtCO2). Axess capnography sampling draws from within the nasal mask, measuring patient exhalation (EtCO2) at the source. The adapter is inserted between the Axess Nasal Mask and Scavenging Circuit, with the flexibility to connect to either the right or left side of the patient mask, depending on which is more convenient for the clinician.


February 2018

First Impressions

The single-use Axess Capnography Adapters are individually packaged in ZipLoc® bags to minimize cross-contamination, and the non-latex material offers protection to patients and staff who have latex allergies.

Highlighting the Axess™ Advantage

If N2O/O2 is used in the practice, sales reps should inquire whether the dentist is using capnography to monitor patient end-tidal carbon dioxide (EtCO2). If a capnograph monitor is being used, the rep might inquire about how the monitor’s sample line is introduced into the system. Not all clinicians are aware that there is now a convenient and easy solution, and many continue to place the sample line within the nasal mask and tape it under the patient’s nose, making it awkward to secure and uncomfortable for the patient. The Axess capnography adapter is easier to introduce into the system, more comfortable for the patient, and it will not potentially disturb the nasal mask seal and allow gas to seep into the clinician’s work zone and into the atmosphere. For more information about the Axess product line, or to request Axess Nasal Mask samples for your doctors, visit us at

Ivoclar Vivadent Editor’s note: Sponsored by Ivoclar Vivadent.

Direct composite restorations

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

Key features include:

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

• Low Shrinkage Stress. A unique filler technology reduces shrinkagestress – an important physical property specifically when polymerizing large Class I and Class II composite restorations. The filler technology in Tetric EvoFlow Bulk Fill keeps the material from pulling away from cavity walls during polymerization, improving marginal integrity.

• Natural Esthetics. While many “bulk fill” composites result in low value o r a gray appearance, Tetric EvoFlow Bulk Fill provides a dentin-like opacity after polymerization. This is the result of Assencio™ technology. Unlike any other flowable bulk fill composite, the material is translucent during placement, allowing for a deep depth of cure, and it becomes opaque during the curing process. The dentin-like opacity provides a more natural-esthetic appearance of the restoration after the final occlusal layer has been placed. The unique technologies found in Tetric EvoFlow Bulk Fill reduce the number of steps in the direct restorative procedure and lead to more durable and natural-esthetic restorations. This flowable composite can be easily integrated into any existing resin-based composite system.

First Impressions

February 2018



KaVo ELECTROmatic System Editor’s note: Sponsored by KaVo Kerr

Primary function: • Air-to-electric electric upgrade system with dual motor and endo options.

Life of equipment: • KaVo’s trusted quality – together with a 3-year warranty and modular system for easy replacement of water filters and tubing – ensure the ELECTROmatic system will last for many years. • KaVo’s MASTERmatic and EXPERTmatic electric handpieces come with a two-year warranty, which can be extended to 2.5 years when maintained with a QUATTROcare plus maintenance system.

Repair or replace? • The ELECTROmatic system’s modular design allows for easy technician-free part replacement for water filters, LED bulbs and tubing. • If a running handpiece becomes hot, the unit must be serviced.

How it works: • By combining the new KaVo ELECTROmatic control unit with KaVo’s industry-leading electric handpieces and a short, powerful, lightweight motor, KaVo provides an ideal solution for synchronized efficiency.

• The KaVo ELECTROmatic is available in three models, which means there is an electric solution for every dental office. The ELECTROmatic is the first air-to-electric conversion system that offers dual motors. With 20 pre-programmed endodontic file systems and reciprocal movement, the ELECTROmatic premium offers a true all-in-one electric platform.

Improvements to the technology:

ELECTROmatic control box: • Dual motor option. •D  entists can choose remote mount display for the best ergonomic viewing position. • Over 20 preprogramed endo file systems. • S MARTdrive sensorless control allows a high torque at low-speed ranges.

February 2018

First Impressions

COMFORTdrive handpiece: • KaVo’s most innovative handpiece – the COMFORTdrive 200XDR – offers a blend of optimal performance and superior ergonomics, with nearly silent operation. Thanks to integrated micromotor technology, COMFORTdrive delivers the precise cutting performance of an electric handpiece, with a light-weight, ergonomic design similar to that of an air-driven handpiece. KL703 LED short motor • The KL703 LED brushless electric motor is 30 percent lighter and 25 percent shorter than other market leading electrics. Paired with KaVo’s ELECTROmatic systems, it connects with any attachment with ISO 3694 (E-style) connection.

Price range: • $1,899-$4,199 MSRP.

Start a discussion with your customers by asking:

What you need to know:


MASTERmatic handpiece: • KaVo Kerr has paired the ELECTROmatic with the MASTERmatic LUX M25 L and the MASTERmatic LUX M05 L Mini High-speeds, which combine small head size with powerful and quite performance. The MASTERmatic high-speed attachments feature a triple-gear system for smooth, reliable operation and patented angles for superior access.

• “Doctor, are you aware that there have been recent improvements made to electric handpieces?” • “Whereas older electric handpieces sometimes overheated, KaVo has addressed this concern with MASTERmatic quality, the QUATROcare maintenance system and the ELECTROmatic’s SAFEdrive feature.” • “Unlike older handpieces, which may have been heavy and bulky, the KaVo KL703 short motor and COMFORTdrive, together with the MASTERmatic M25L and M05L, have addressed this issue.”

Addressing your customers’ concerns: • A KaVo quality handpiece has longer longevity, thereby providing the dental practice with peace of mind. With three models from which to choose, the KaVo ELECTROmatic offers an electric solution for every office, no matter what its needs and budget is.

Preventive Technologies, Inc. (Preventech) Editor’s note: Sponsored by Preventive Technologies, Inc.

Is your dental

customer’s practice compliant with infection control standards in your state? The e¯ sa® (extended straight attachment) disposable prophy angle brings super-simple compliance to all 50 states. Currently, 39 state dental boards subscribe to the CDC Guidelines, which recommend that all dental handpieces and their attachments be heat-sterilized between patients. If a semicritical item is heat-sensitive, DHCP should replace it with a disposable alternative1.

In 11 states2, state dental practice acts mandate the heat sterilization of handpieces. With infection control and sterilization of instruments becoming more transparent to patients, more states may be on the verge of adopting similar mandates. esa ¯ is compatible with a number of heat-sterilization-tolerant handpieces, including Midwest® Shorty®, Rhino®, Star®Titan and our esa¯ ® mate® lube-free handpieces. Because esa ¯ eliminates the nose cone, it is 50 percent lighter than traditional handpieces and it costs less to use ® than both traditional handpieces and DPA connections. esamate ¯ hand® pieces are available in two models: esamate ¯ ST, with an aluminum ® housing that weighs just two ounces, and our new esamate ¯ MW, which features a stainless steel housing and weighs 3.2 ounces. Both handpieces are heat-sterilization-tolerant, offer a 360° swivel and connect quickly and easily to esa ¯ ® disposable prophy angles. They feature airdriven performance, which requires no batteries, and run at 5,000 rpm, which is perfect for prophys. They are backed by a two-year warranty.

With the movement in compliance shifting toward sterilization, why offer your customers a handpiece that’s not heattolerant? Instead, talk to us about esa ¯ and the lube-free esamate ¯ prophy system. Or, if your customers already own a Midwest Shorty, Rhino or Star Titan handpiece, have them put an esa ¯ on it and be compliant wherever they are located. For samples of the esa ¯ DPA or more information, visit

Addressing your customers’ concerns Some dentists may object that it is too costly to purchase the number of handpieces required to be in compliance with heat sterilization recommendations or requirements. However, the CDC Guideline states, “if a semicritical item does not come in contact with mucous membranes or non-intact skin,” heat sterilization is not required. In these states, using an esa ¯ ®DPA, together with a plastic barrier on the handpiece, reduces the cost of infection control in half and puts them in compliance with their state dental practice act. Both the esa ¯ ®DPA and esamate ¯ handpieces provide fast and easy changeover between patients.

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

First Impressions

February 2018



Solmetex Editor’s note: Sponsored by Solmetex

As part of the EPA Dental Regulation that went into effect in July 2017, not only do dental practices in the U.S. need to install an ISO 11143:2008 certified amalgam separator to capture harmful mercury from their dental practice waste water, they now must also dispose of dry amalgam waste in a clearly marked amalgam bucket for proper recycling. Solmetex now offers the perfect combination to insure your account is in compliance. In every shipment of our award-winning NXT Hg5 Amalgam Separator, we include a Practice Waste Solutions Amalgam Bucket for the disposal of dry amalgam waste.


February 2018

First Impressions

Practice waste perfect.

Contact & Amalgam Non-Contact Capsules Amalgam


Chair-Side Traps Teeth with Vacuum Amalgam Filters



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• New compact design for easy and flexible installation • ISO 11143 certifed • Eco-friendly packaging is 100% recyclable

• Ensures compliance with new EPA Dental Amalgam Rule • Affordable, one-stop mail-back service

• Includes a Practice Waste Solutions amalgam bucket • Certificates of compliance available 24/7 • Made in the USA | 800.216.5505

The New NXT Hg5 Amalgam Separator* Special Rebate Offer includes: • Practice Waste Solutions Amalgam Bucket

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Whenever an account purchases and recycles an Hg5 series collection container or any of our Practice Waste Solutions products (amalgam, lead, photo-chemical, biohazard/sharps), Solmetex offers Certificates of Compliance on our website, accessible 24/7, so the dental practice can feel assured they have proof of compliance at all times. Distributor sales reps can initiate a discussion with their dental customers by asking: • “Doctor, how are you currently storing, disposing and/or recycling the following items, which are considered dry amalgam waste: chair-side traps, amalgam capsules, teeth with amalgam fillings, contact and non-contact amalgam and vacuum filters? All these items should be recycled in a properly labeled amalgam bucket.”


1IMP100_0118 1/15/18 11:41 AM

Solmetex now offers the perfect combination to insure your account is in compliance. In every shipment of our award-winning NXT Hg5 Amalgam Separator, we include a Practice Waste Solutions Amalgam Bucket for the disposal of dry amalgam waste. Some dentists may not feel an immediate need to acquire an amalgam separator or amalgam bucket. It’s true they have until 2020 to get those items. Sales reps may remind them, however, that with the entire country currently under regulation, unit pricing and installation costs will most likely increase as time goes by. Dental practices can rely on Solmetex’s complete solution for all of their EPA dental rule compliance needs with peace of mind that the products are compliant with EPA regulations and are backed by the support of Solmetex.

First Impressions

February 2018



Sterisil Editor’s note: Sponsored by Sterisil

Dental waterlines are an ideal breeding ground for undesirable bac-

teria, viruses and pathogens, which can be tough to detect and even harder to kill. For over 20 years, Sterisil has pioneered and perfected the delivery of silver-based residual disinfectants into dental unit waterlines. Sterisil products kill and maintain odor-causing bacterial content, making it safe for patients, staff and equipment. With each of our offerings, we create not only a product, but a complete protocol that is easy and reliable. Sterisil offers true all-in-one products, which include a shock treatment specially formulated for use with our maintenance products. Doctors should not have to pay a premium to achieve a product’s advertised level of disinfection. The result is a complete product line that disinfects to ≤10 CFU/ml. That’s 50 times better than the ADA and CDC standards for bacterial content, with no added costs. Staff involvement in the disinfection process is reduced and optimized with simple protocols designed to keep the process intuitive and hassle free. Sales reps can initiate a discussion with their dental customers by asking: • “Doctor, have you considered how your waterline cleanliness affects your practice’s liability exposure?” • “Did you know shocking is necessary to achieve the maximum bacterial control with most waterline maintenance regimens?” • “Are you using an approved shock with your waterline maintenance products?” • “How much time and money are you and your staff currently spending on waterline maintenance?”


February 2018

First Impressions

• “Are you certain your dental effluent water meets both CDC and ADA standards for bacteria reduction?”

Potential customer objections: • “I shock once a week so there is no need for a maintenance product.” • Unfortunately, shocking by itself is not enough. Without a residual disinfectant present, bacteria levels will rise and pose a threat to patients and staff. • “I use distilled water in an independent bottle reservoir so there is no need to have a disinfection protocol.” • Distilled water is not dental water. Though an independent reservoir is isolated from municipal contaminants, without a residual disinfectant present, the bacterial problem will persist. According to OSAP, “These devices are of no value, however, without germicidal treatment, even when sterile water is used in the reservoirs. Users must follow routine maintenance protocols to control biofilm formation.”* • “I flush and dry my lines each day, so there is no need to treat my water.” • At one point the CDC recommended dental water lines be flushed at the beginning and end of the day as a bacterial mitigation method. This method has since been disproven. According to ADA, “Dental unit water that remains untreated or unfiltered is unlikely to meet drinking water standards…”

Sunstar Editor’s note: Sponsored by Sunstar

Butler® Monsterz chairside

products from SUNSTAR – a globally recognized oral care company also known for GUM® and GUIDOR® brands – are now available to dental professionals who may be seeking a holistic solution to make young patients’ prophylaxis appointments more fun and efficient. Butler Monsterz now offers a regimen of new disposable prophy angles, prophy pastes, and fluoride varnish. A choice of flavors and colors available in Butler chairside products create empowerment of young patients in the chair, so they become interactive and engaged during the dental visit. It will customize each patient’s visit by allowing young patients a choice and control, helping to drive their interest in oral hygiene by creating two-way communication during procedures and turning the dental visit into a more positive, relevant, fun experience. Between visits, patients can enjoy Monsterz care at home by using the GUM Monsterz toothbrush. Distributor sales reps can initiate a discussion with their dental customers by asking: • “Doctor, what would you think about a solution for making the pediatric patient’s dental visit more fun and positive, enticing them to come back to your office for their next appointment?” • “Did you know Butler and GUM Monsterz products from Sunstar can help you create a continuity of patient care, from chairside to home, all under a consistent theme and message?”

Customer questions and objections: • “Why does Butler Monsterz offer variety pack in Prophy Paste and Varnish?” •  Butler Monsterz primarily focuses on empowerment of young patients through choice, as it creates twoway interaction and engagement. Hence, the variety pack holds valuable elements in making patient’s visit more successful and positive. • “I’m okay with the current product I’m using at my office.” • Monsterz products can build a holistic solution, which you may want to deliver to young patients and their parents. This can be a great opportunity for you to educate them about the importance of dental visits and daily oral hygiene at home. Plus, Monsterz is an exclusive brand from Sunstar, which will attract the interest of your patients and their parents.

The Monsterz goal is to create fun and engaging dental visits for young patients, making their next appointment that much easier, and offering a fun oral hygiene solution for at-home preventive care. By choosing Monsterz, dental professionals can present their young patients with a continuum of fun oral hygiene that extends from chairside procedures to at-home care.

First Impressions

February 2018



Tuttnauer Editor’s note: Sponsored by Tuttnauer

The Tuttnauer EZ11Plus fully automatic sterilizer – the “The Perfect Primary Unit” – paired with the Valueklave 1730 manual sterilizer – “The Perfect Cassette Alternative Unit” – make the “The Perfect Pair.” The EZ11Plus fully automatic sterilizer, “The Perfect Primary Unit,” is designed to meet the most current sterilization standards ANSI/AAMI ST55. The EZGlide self-locking door is ergonomically friendly and can be opened and closed effortlessly. The EZView display screen is full color and easy to read, even from a distance. As a convenience for the operator, the EZFill water reservoir can be filled with distilled water from the top of the unit, as well as through the front fill funnel located inside the door. The EZ11Plus model features an 11inch chamber and includes five large trays. For those offices using cassettes, it can accommodate four full-size cassettes and four half-size cassettes. The EZ11Plus also features a dynamic air removal technology and an active closed-door HEPA filtered air-drying system to maintain sterility and ensure efficient drying of packs and pouches. It comes standard with a USB port to transfer cycle data, a network port to connect a local network and provide remote monitoring of the system, and an optional printer. Tuttnauer is the only manufacturer to offer a two-year warranty on parts and labor and an additional 10-year warranty on the chamber for all of its fully automatic autoclaves.


February 2018

First Impressions

The Valueklave 1730 manual sterilizer, “The Perfect Cassette Alternative Unit,” is small, fast and economically priced. The bright, easy to use panel is designed with the operator in mind. Its fast cycle time sterilizes unwrapped instruments in 11 minutes (come-up time, sterilization exposure and exhaust). The seven-inch chamber size comes with three small stainless-steel trays and there is no need for special cassettes. It effectively dries wrapped instruments and is larger than some single cassette units. The Valueklave 1730 comes with a one-year warranty on parts and labor and an additional 10-year chamber warranty. Tuttnauer continues to offer the largest selection of autoclaves to the marketplace. Their single focus on sterilization and infection control enables them to offer products to help practitioners meet today’s challenging workloads and regulatory requirements. Sales reps can initiate a discussion by asking: • “Doctor, what is the volume of items at your practice that needs to be sterilized? Has this volume increased? The volume of items that needs to be sterilized will determine the size of your autoclave. An experienced distributor can recommend the ideal autoclave according to chamber size.” • “Which autoclave will deliver the best reliability for your investment? Some things we should consider are: What is the warranty and how does service work?”




• 2 Year Parts & Labor Warranty* • 10 Year Chamber Warranty

use promo code FirstImpressions2018 and receive a $50 rebate on any new autoclave. Visit for more details.




*On fully automatic models only

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

Did You Know?

Why is this important?

Our EZPlus models offer a closed-door drying system.

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


EZPlus 9” & 11” Chamber Sizes Fully Automatic Autoclaves

9” & 10” Chamber sizes Manual Autoclaves




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EZ 9” & 10” Chamber Sizes Fully Automatic Autoclaves

Valueklave 1730 7” Chamber size Compact Autoclaves

Elara11 - Class B 11” Chamber size Pre and Post Vacuum Autoclaves

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3870 15” Chamber Size Large Capacity Autoclaves

Autoclave Cleaner


Hager Worldwide Editor’s note: Sponsored by Hager Worldwide.

Dental offices continually

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


February 2018

First Impressions

In addition, the airflow in the mirror head greatly reduces fogging – a common complaint by hygienists who rely on conventional mouth mirrors. When they don’t need to continually stop to clean the mirror face, hygienists can work much faster and efficiently. Finally, the Mirror Suction is simple to install or uninstall, making it truly a plug-and-play component. The Mirror Suction comes in convenient kits, which include all necessary components, such as mirrors, tubing and adapters. All Mirror Suction components are autoclavable for easy cleaning and maintenance, and the mirrors are available in both single and double-faced versions. Sales reps can start a discussion with their hygiene customers by asking if they would find a mouth mirror with suction helpful during ultra-sonic scaling and when applying sealants. If hygienists question the suction ability of the mirror, reps should explain that the strategic placement of the holes on the mirror head permit consistently excellent aspiration. For more information, please visit


The Value of Synthetics Nitrile and neoprene gloves offer benefits to the dental practice.

Ergonomics, protection and reliability are just some of the factors that impact your dental customers’ choice of gloves. Today, more and more dentists are exploring synthetic glove alternatives to latex, such as nitrile or neoprene, which offer comparable comfort and grip, as well as a number of other benefits. A worthwhile investment Investing in reliable gloves, which will enhance – not impede – clinicians’ work – can offer the entire dental team peace of mind and save the practice time and money. Indeed, dentists run several risks when they cut costs by opting for a less expensive – and potentially less reliable – glove. Less expensive gloves are associated with several disadvantages, including:


February 2018

First Impressions

Investing in reliable gloves, which will enhance – not impede – clinicians’ work – can offer the entire dental team peace of mind and save the practice time and money. Indeed, dentists run several risks when they cut costs by opting for a less expensive – and potentially less reliable – glove.

• Lower quality. Less expensive, lower quality gloves have a higher Acceptable Quality Level (AQL). Gloves with a low AQL indicate fewer pinhole defects per lot and higher levels of barrier quality and consistency, and generally have fewer rips and tears during use. •P  oor ergonomics. Clinicians sacrifice ergonomics when they purchase less expensive gloves. Gloves that are ergonomically designed can help reduce hand fatigue and hand related injuries on the job. Clinicians should use a certified ergonomic glove for the best fit, feel and protection.

• Low quality polymers. Less expensive gloves are associated with low quality polymers, whereas quality exam gloves use a second-generation exam glove polymer, which provides a flexible, strong and stretchy fit for the best possible comfort and protection. • Low reliability. Some lower quality glove manufacturers do not adhere to the ISO 13485 standard, a standard for the design of quality systems specific to medical devices. Exam gloves that fail to adhere to ISO 13485 are potentially less reliable.

The benefits of nitrile and neoprene More and more dentists are recognizing the advantages of nitrile and neoprene exam gloves. Both options are well suited to the dental practice and they offer an alternative to latex gloves, which have been associated with type I latex allergy concerns for both clinicians and patients. Nitriles tend to be a good glove for every day use. Nitrile gloves fit well and offer overall good protection and reliability. Some manufacturers offer half size nitrile exam gloves, which provide the greatest fit and comfort for that material type. Neoprene – or cholorprene – gloves are considered to be one of the most flexible glove options on the market. They offer optimal fit and comfort, including an excellent wet grip and a nice, stretchy feel. Using an ergonomically designed glove helps protect dentists and their team from musculoskeletal diseases, such as carpal tunnel.

• Office Manager. Office managers often make the final purchase. While they look to save money for the practice, they want to ensure the entire dental team is satisfied with the products they use and can work efficiently. Distributor sales reps can initiate a discussion with their dental customers by asking a few probing questions: • “How do you like your current exam gloves?” • “Do you currently feel any fatigue or pain in your hands?” • “Do your gloves feel too small or too big?” • “Are your gloves offering the wet grip you need?” • “Do you think your overall productivity is affected by the type of glove you use in your practice?” • “Have you tried the newest film technologies?” • “What’s important for you when choosing an exam glove?”

Some dentists and hygienists are reluctant to try a new glove option. Sales reps can remind these customers that there are several new technologies available, which are ergonomically designed, soft and stretchy, offer tactile sensitivity and provide optimal protection. For those customers reluctant to try a synthetic glove material, remind them that neoprene gloves resemble latex and offer similar stretch, flexibility and wet grip.

Working with your customers There are a few key decision makers in the dental office: • Dentist. While dentists often own their practice, they don’t necessarily make all of the purchasing decisions or have the final word on what glove type is used. • Hygienist. Hygienists are not afraid to voice their opinion! They know which products they do and don’t like and tend to be champions of products they can trust.

Some dentists and hygienists are reluctant to try a new glove option. Sales reps can remind these customers that there are several new technologies available, which are ergonomically designed, soft and stretchy, offer tactile sensitivity and provide optimal protection. For those customers reluctant to try a synthetic glove material, remind them that neoprene gloves resemble latex and offer similar stretch, flexibility and wet grip. Finally, distributor sales reps can remind their dental customers that saving a few pennies on gloves up front can cost them down the road. Inexpensive gloves are more likely to tear and may offer less protection and comfort.

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

First Impressions

February 2018



Hand it to the Glove Your customers deserve a great fit

When it comes

to infection control, small ticket items can have a huge impact on the dental practice. Take the glove: A barrier to infection, illness and injury, it protects both the dental staff and their patients. Contrary to what some dentists may believe, saving a few cents by purchasing lower quality gloves can compromise the health of everyone who enters the practice.

Glove options Although powdered gloves were banned by an FDA ruling in December 2016, and officially in January 2017, due to substantial risk of illness or injury to exposed individuals, dentists and their staff continue to have several options from which to choose – each with its advantages and disadvantages: • L atex gloves. Latex gloves have long been considered a trusted glove material for dental markets. Made from natural rubber latex, these gloves are known for their flexibility and fitment properties, and offer reliable barrier protection. However, some practitioners and patients have allergic reactions to latex gloves, widely deterring their use. In turn, latex-free gloves, such as vinyl, nitrile and polychloroprene materials, have gained popularity in the dental office.


February 2018

First Impressions

• Vinyl gloves. A more economical option than latex, vinyl gloves are made with polyvinyl chloride and, as such, are free of latex allergens. Glove wearers, however, feel that vinyl gloves do not offer the same flexibility as latex gloves.

• Nitrile gloves. Like vinyl gloves, nitrile gloves are made of synthetic rubber material – one that features similar characteristics to natural rubber and offers much of the same in flexibility and durability as latex gloves. Whereas some doctors may have shied away from nitrile gloves in the past because they cost more than other glove options, newer generations of nitrile gloves are thinner – and less expensive. That said, there have been growing concerns of allergic reactions to chemical accelerators used in nitrile glove manufacturing; in response, newer, accelerator-free nitriles have become available.

• Polychloroprene gloves. Polychloroprene gloves have gained interest in the dental market. They are made with a synthetic rubber said to closely match the flexibility and barrier protection of latex gloves. In addition, polychloroprene gloves do not raise allergen/dermatitis concerns associated with latex and nitrile gloves.

the office manager, hygienist or dental assistant may make the final call, making it important for sales reps to engage the whole office. Additionally, because glove selection is a personal choice, and each practitioner can have his or her own preference, reps should be prepared to help their customers stock more than one glove type.

Working with the customer

Sales reps can initiate a discussion about gloves by asking a couple of probing questions, such as: • “What are your concerns regarding natural rubber latex gloves versus synthetic rubber gloves?” • “What are your priorities regarding glove selection? Flexibility, tactile sensitivity, cost, etc.?”

Generally, any gloves that are rated as an exam grade are considered appropriate for use in the dental practice. For more critical procedures, however, surgical gloves may be required. Sales reps should research current health and safety CDC guidelines and OSHA regulations to ensure they offer their customers the right solution. The decision maker in charge of glove purchases may vary from one dental practice to the next. Anyone from the dentist to

Some customers may find it confusing that different gloves are packaged in different quantities – ranging from 100 to 200 or even 300 gloves per box. Sales reps can do their customers a service by calculating a standard unit of cost across the board. At the same time, they should remind their customers that, while it’s important to make economical choices, it never pays to save money at the expense of staff and patient safety.

As a general rule of thumb, latex, nitrile and polychloroprene gloves all are highly rated for comfort. Latex and polychloroprene gloves are also said to offer better fitment.

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

First Impressions

February 2018




2018: If there’s one thing that hasn’t changed in dentistry, it’s

that the industry is constantly changing. Dental practices continue to expand, both in number and size of locations. More patients than ever before are seeking dental treatment. At the same time, it’s become increasingly competitive for dental practices to attract and maintain patients. As a result, dentists and their staff are turning to new technology to offer cuttingedge services and foster the clinician-patient bond. Industry experts discuss changes we can expect to see in 2018, and how distributor sales reps can help their dental customers stay ahead of the game and continue to be leaders in patient care.


February 2018

First Impressions

First Impressions

February 2018



When, not If New technology will continue to drive the dental industry in 2018.

The dental industry is experiencing more change than ever before – a

trend that’s likely to continue in 2018, according to Brian Evans, director of sales for Benco Dental’s Western District. “Customers are always trying to identify methods to better differentiate their practices, and here we see a move toward more dental coaching for the independent dental providers,” he says. Technology will continue to “reign,” Evans predicts. “Dentistry is about a decade behind the tech boom the medical field has experienced. Prospecting in every office for the when – not the if – sales will be key. If we aren’t creating the opportunity, someone else will. Customers are expecting online ordering ease and we have positioned ourselves at Benco.” For example, every dental practice should have 3D CBCT, he points out. “These standards of care are necessities when placing implants, or during endodontic procedures. These are opportunities for the dental customer to increase efficiency and produce more with less by leveraging technology and partnering with those who can provide a path to these objectives. Our customers face fierce competitive pressures daily in seeking ways to run a profitable business.”

Working with customers This year, sales reps will continue to be challenged to help their dental customers identify new revenue sources for the dental practice, notes Evans. “In 2018, reps will need to sell the full service offering and demonstrate value,” he says. “They will need to deep dive into innovation to increase patient flow and practice offerings.” Once they identify new market opportunities, distributor sales reps should directly involve the manufacturer, he adds.


February 2018

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Brian Evans

“Help practices look at their business through a Starbucks lens. Challenge your doctors and staff to compare their business to other businesses outside of the dental profession. How do they compare? What do things like appointment scheduling and reception areas look like at other medical facilities?” – Brian Evans, director of sales for Benco Dental’s Western District

“It’s important for sales reps to join meetings with their customers, learn from their dental customers and to stay relevant,” Evans continues. “Help practices look at their business through a Starbucks lens. Challenge your doctors and staff to compare their business to other businesses outside of the dental profession. How do they compare? What do things like appointment scheduling and reception areas look like at other medical facilities? “Sales reps should help their customers grow and better their practices by educating them about current products and procedures,” he continues. “When dental sales reps offer better products and technology, the clinicians and staff are able to provide a more comfortable, satisfying and rapid dental visit for the patient. When the patient visit is more streamlined and less anxiety-ridden, the patient is happier, more fulfilled and feels more connected to the clinician and staff. It is the dental rep that brings this ever-evolving offering of products and technology to the practice doorstep.” Indeed, cutting-edge technology and products enable general practitioners to offer more and better services, Evans points out. “I expect continued advancement from 3D and CAD/CAM technologies to accommodate this need. These shifts and opportunities play into the dayto-day doctor-rep interactions. Being relevant requires all parties to be educated on these innovations. I envision that more reps will challenge their doctors to venture into new realms.”

Change and Innovation Consolidation, the advancement of digital technologies and an increase in patient awareness will continue to drive the dental industry in 2018.

If there’s one thing we can count on in 2018, it’s that the dental industry

While the majority of dental practices and laboratories across North America will continue to experience change and innovation. Consolidation, emerging digital continue to work in an analog environtechnologies and an increase in patient education will play a major factor, notes ment, many have already incorporated Chet C. Spivey, vice president-marketing, Ivoclar Vivadent, Inc. digital workflows to improve production efficiencies, he continues. “While digital technologies – including “Consolidation will continue across the industry, affectdigital radiography, intra-oral cameras and more – have existed ing dental practices, laboratories, distributors and manuin the dental practice for a while, the trend towards the digital facturers,” says Spivey. “It’s placing downward pressure on practice is growing faster than ever. Digital technologies, such as supply costs and increasing the need for more productive cone beam computed tomography (CBCT scans), provide dental workflows. One solution for dental laboratories and dental professionals with access to more information for improved dipractices will be the incorporation of digital technologies agnosis and treatment, leading to more successful results. and workflows.”

First Impressions

February 2018



“We expect more of the solo and small group dental practices to incorporate digital technologies at some level,” says Spivey. “The advantage to any dental practice or dental laboratory is that digital technology can be introduced at any level. As a result, dentists can enter the digital age by scanning restorations and sending them to the lab for fabrication, or they can choose to utilize a complete chair side CAD/CAM solution. “Laboratories can enter by scanning conventional impressions (such as vinyl polysiloxane, or VPS) or by receiving scans from dentists. From there, there may move towards a partial or complete digital fabrication workflow. In the partial workflow, labs may choose to design the restorations digitally and mill or print wax-ups to be utilized in the pressing technique. In the complete workflow, restorations can

“More patients will research their options prior to visiting the dental office, making themselves a part of the treatment planning process, and dentists will need to be prepared to discuss treatment options with a more educated patient.” be milled to a full-contour and characterized. In any case, these options all lead to a higher level of information and communication between the dentist and the laboratory. “This new level of communication, together with the improved quality – and quantity – of information, sets expectations for everyone, resulting in more successful outcomes and increased patient satisfaction,” Spivey adds. At the same time, patients continue to be better educated through the Internet, social media and word-of-mouth, Chet C. Spivey Spivey points out – a trend that will continue into 2018. “More patients will research their options prior to visiting the dental office, making themselves a part of the treatment planning process, and dentists will need to be prepared to discuss treatment options with a more educated patient.”


February 2018

First Impressions

Indeed, patient education and involvement in the treatment plan is key to maximizing patient satisfaction, he explains. “Team members should involve the patient when selecting materials, shades and production options,” he says. “They should discuss material types and how they impact longevity and esthetic potential. Sales reps can assist in the process by providing their dentists with additional patient education tools offered by materials manufacturers. The more patients are involved in the decisionmaking process, the more ownership they will have in the final outcome. Today patients are able to make some choices with composite mock-ups, digital imaging or photos of past cases. In the future, augmented reality (AR) will become the standard for patient education.”

Key opportunities As the trend toward digital dentistry advances, manufacturers will continue to launch new material and equipment innovations for the digital practice, according to Spivey. “Soon dental professionals will have more material and equipment options available to choose from than ever before,”

and that they include the entire dental team in this process, as every member will play a key role in the new digital workflow. Attending educational programs together with their dental customers will be vital to successful integration.” Furthermore, as new technologies are introduced so rapidly, it is more important than ever that distributor sales reps maintain close working relationships with their manufacturer sales reps, Spivey points out. “Manufacturer sales reps are experts within their scope of these technologies,” he explains. “Once leads are qualified, manufacturer reps can step in to provide additional information, answer questions and offer advice, helping dentists make decisions that are right for their practice. Manufacturer reps can become part of the integration process simply by reviewing new equipment and material processes upon delivery of new technology or a new system.”

Moving forward he says. “This will lead to increased competition and lower prices, extending the market to practices that may not have considered investing in digital technologies in the past.” In turn, it will be critical for dental sales reps to maintain a strong knowledge of digital technologies and workflow options, in order to guide their clients in the direction that makes most sense for the practice, says Spivey. “Sales reps should continue their education on the advancements of digital dentistry by attending programs and working closely with leading manufacturers in the field of digital dentistry,” he advises. “Sales reps will need to understand what options are available in order to advise their dental customers on which technologies best fit their needs. “While digital dentistry is very exciting, one of the greatest challenges dentists face is the ability to integrate these new technologies and workflows into their practices,” he continues. “It is important that dental sales reps have a clear understanding of the workflows,

Over the next five years, the growth of corporate dentistry – or DSOs – will escalate, says Spivey. “It is estimated that 30 – 40 percent of dental practices in the United States will be part of a large group practice in the next five years,” he points out. “These practices will be interested in lowering costs and increasing productivity. Dental sales reps will need to become versed in business and ready to introduce products and workflows that will allow the practices to achieve the financial goals of the practice owners. “Aside from digital materials and technologies, materials manufacturers will also develop materials and system with a focus on production efficiencies,” he says. “The most recent advancements have been the launch of bulk fill composites, universal adhesives and accessories or delivery devices designed to streamline the treatment process. Fewer procedural steps not only lead to more efficient treatment, they also result in less opportunity for error. Dental sales reps should continue to introduce these new materials to their dental customers, permitting them to be more competitive and maximize – Chet C. Spivey, vice presidentproduction and profitability.” marketing, Ivoclar Vivadent, Inc.

“We expect more of the solo and small group dental practices to incorporate digital technologies at some level. The advantage to any dental practice or dental laboratory is that digital technology can be introduced at any level. As a result, dentists can enter the digital age by scanning restorations and sending them to the lab for fabrication, or they can choose to utilize a complete chair side CAD/CAM solution.”

First Impressions

February 2018



A Time for Growth

The emergence of group practices represents new opportunity for reps.

The dental landscape is changing fast. For the first time, dental ser-

vice organizations (DSOs) are growing more rapidly than solo practices, and distributor and equipment reps have a greater opportunity than ever to help their customers grow.

“We continue to experience sustained growth specific to the DSO space,” says Ted Kehagias, vice president of dental sales, Midmark Corp. “Private equity is fueling the mid-market space (group practices with 10-100 offices), which is growing the most rapidly. This trend presents opportunities for all of us in the dental industry to offer innovative solutions that are unique to the solo practitioners and emerging DSOs (10-20 offices), in addition to the elite DSOs (100+ offices).” As dental practices expand, they are tasked to differentiate themselves, he


February 2018

First Impressions

Ted Kehagias

continues, and social media continues to be a reliable way for them to engage with the community. “Practitioners will continue to count on social media to differentiate their practice. “As more families rely on social media to help them select a dental practice, simply having a website isn’t enough anymore,” he points out. “Dentists can utilize testimonials, videos, comments and likes, for example, to create their own brand and be more engaging with their patients.” They must create an awareness and educate the community on the health benefits they provide to their patients, beyond fillings, cleanings and extractions, he adds. At the same time, solo and small group practices will continue to explore ways to bring more specialists in-house,

Kehagias notes. “Patients would rather avoid having to visit several offices for multiple procedures,” he says. “Therefore, we see a trend evolving where more dental practices will provide specialty services in the dental office or in one location. This creates an opportunity for sales and equipment reps to help their dental customers design spaces that enable clinicians to work together productively and efficiently in order to provide a better patient experience while reducing dental visits.”

The unique differentiator Now more than ever, sales reps and equipment specialists must position themselves as valued partners with their dental customers, who offer solutions that will help their practices continue to grow and consistently improve their patient services, Kehagias points out. “For existing practices, we have to help them find opportunities for growth. At the same time, we need to uncover – and address – their pain points. We need to help dentists discover the unique differentiator that truly makes them stand apart from their competition.”

Indeed, most clinicians today understand that the overall cost of healthcare – including the cost of insurance plans – is less when patients get regular oral and health checkups. “For this reason, Kaiser Permanente has begun designing dental operatories in their healthcare facilities,” says Kehagias. “Similarly, I recently visited the 11th St. Community Health Center in Philadelphia, which treats the whole person, offering a transdisciplinary approach to deliver primary care, behavioral health, dental services and health and wellness programs to children and adults. We see a developing trend to provide a holistic approach to patients’ overall healthcare. “Our challenge is to design and introduce the technology, equipment and services that can help our customers facilitate a better patient experience,” says Kehagias. “We are experiencing IoT (Internet of Things) connected devices, which are designed to track service needs and automatically alert the

“Patients would rather avoid having to visit several offices for multiple procedures. Therefore, we see a trend evolving where more dental practices will provide specialty services in the dental office or in one location.”

As an example, Midmark advises dental practices on instrument processing, enabling them to follow regulations and protocols, and process instruments safely to provide a greater standard of care, Kehagias continues. “It’s becoming more and more important for us to help dental practices pinpoint a differentiator to showcase their brand,” he says. This is especially important as younger dentists prefer to make their purchasing decisions online, rather than seeking the advice of their sales reps, he adds. In light of that, Kehagias recommends that reps take the following steps: • Schedule regular face-to-face meetings with dental offices. This is becoming increasingly challenging, as many dental practices have multiple offices. But, at the very least, reps should schedule quarterly meetings with customers. •H  elp dentists create an environment that is welcoming, reduces patient anxiety and promotes the office brand. •H  elp dentists educate their patients about the services they provide in addition to routine checkups and fillings. It’s important that patients understand that oral health is central to one’s total health. Reps can help their customers educate their patients on the value of regular checkups, which can decrease their risk of diseases like diabetes and heart disease.

– Ted Kehagias, vice president of dental sales, Midmark Corp.

dealers and manufacturer reps when equipment requires repair. As dental practices get busier, it will become increasingly important for the equipment in the practice to communicate potential failures before it fails. “Today, the supply of dentists continues to grow,” says Kehagias. “There are more dentists per capita, more young dentists (where the average age of all dentists is declining) and more female dentists.” At the same time, pediatric visits are at an all-time high, he notes. “Dental visits among children have risen to 48.5 percent, largely due to the Affordable Care Act. As these trends continue to evolve, and dentists provide services to deliver a higher level of care, dental manufacturers and distributors will be required to design equipment and offer services to meet the new challenges dentists will face. Distributors and manufacturers will require the knowledge and expertise necessary to design environments unique to the growing demands of dental practices.”

First Impressions

February 2018



Pain Management Improved technology and delivery systems have made it easier for dentists to keep patients comfortable and calm BY LAURA THILL

The dreaded needle!

For most patients about to receive an anesthetic, it’s their biggest nightmare. And, the last thing dentists want is for their patients to be uneasy in the chair. Contrary to what many patients believe, the needle isn’t the greatest source of their pain; the majority of pain comes from the anesthetic itself, according to experts.


February 2018

First Impressions

Pain: A major concern

“I am perplexed at how a dentist can quibble over the cost of new technologies that enable him or her to provide better quality pain control, more easily, more comfortably and with increased safety.

Needle: Addressing misconceptions

For most patients, receiving an injecWhile more dentists are incorporating tion is the most “fear-inducing” aspect Kovanaze in their practice, needle inof a dental visit, says Stanley Malamed, jections remain a common and efficient D.D.S., Emeritus Professor of Dentistry, means for delivering anesthetics. By seOstrow School of Dentistry, University of lecting the right needle size, dentists can Southern California, Los Angeles, CA. provide injections safely and more comIn fact, it is estimated that some 30 to fortably, notes Matt Woolson, product 40 million persons in the United States manager, Septodont. However, sales reps avoid seeking dental treatment because may have to help clear up a few misconof their fear of pain and needles. ceptions for their dental customers. Malamed – a consultant for St. Re“Many dentists hate giving injections natus – believes that “pain control is the as much as their patients hate getting most important aspect of dentistry, as them,” says Woolson. But that needn’t be most dental treatment cannot be perthe case. Features such as needle sharpformed without adequate pain control.” ness, length, bore size and quality all impact Not only do most patients fear the the injection delivery, he points out. “Most – Stanley Malamed, D.D.S. pain associated with an injection, many dentists don’t know what needle brand they dentists are equally frustrated by their inability to successfully – and consistently – manage their patients’ pain, Malamed points out. Making matters worse, some needle-phobic patients have been known At Septodont, needles and pain management can mix – as long as the needles to faint (syncopy) – the most common are high quality and designed with optimal patient comfort in mind. First and medical emergency in dentistry, he notes. foremost, needle sharpness is key, notes Matt Woolson, product manager, This – together with concern that the use Septodont. In addition, the company offers the Septoject Evolution needle – a of a syringe and needle can lead to inaduniquely designed needle featuring a beveled scalpel – and the Septoject XL, vertent needlesticks and potential transwhich features an oversized lumen or bore. “The Evolution needle is so sharp, mission of such diseases as Hepatitis C it is only indicated for infiltrations and PDL injections,” he says. “There is too and HIV – have led some doctors to exmuch risk using it on block injections, where it could damage a nerve.” plore a needleless alternative. “Kovanaze – a nasal spray consisting of 3 percent tetracaine and 0.05 percent oxymetazoline – effectively provides anesthesia to maxillary non-molar teeth use,” he notes. Yet, the manufacturing process and quality of materivia a nasal spray,” he explains. “No needles are involved. als can have a big impact on the efficacy of the needle. “Most dentists dislike administering palatal injections beDental needles are typically available in three gauges cause, in their mind, they hurt,” Malamed continues. “The same (25-gauge, 27-gauge and 30-gauge), according to Woolson. is the case for their patients. Offering a new technology that proThe smaller the needle gauge, the larger the needle size. In advides profound anesthesia without the need for injection should dition, the 25-gauge and 27-gauge needles are available in two be well received by both doctors and patients. Further, there is lengths (long and short), while the 30-gauge needle is available no anesthesia extra-orally, so the upper lip does not get numb in short and extra-short. Dental schools encourage students to or droop.” This is a “significant advantage in some esthetic denuse a 25- or 27-gauge needle, and most commonly a 25-gauge tistry procedures,” he adds, as it won’t impair the patient’s ability long needle and a 27-gauge short needle is used. However, to eat, drink or speak. practicing dentists tend to favor the 30-gauge needle because In addition, the availability of a relatively new drug called it is the smallest size available, he notes. Indeed, many dentists OraVerse – a local anesthesia reversal agent introduced to the have a misperception that a smaller needle size is associated market in 2008 – helps reduce the amount of time a patient with less pain for the patient. “This is absolutely wrong and, in is numb. some cases, dangerous,” he says.

Looking sharp

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February 2018



“A 30-gauge needle is only available in short or extrashort,” Woolson continues. “Extra-short needles are designed for use with PDL injections, while short needles are designed for infiltrations. (Long needles are designed for block injections.) Some dentists use 30-gauge short needles for block injections, but that is ill-advised, he says. This particular needle is 25 mm long, he notes. If it is used for, say, an inferior alveolar nerve block injection, and the dentist needs to advance the needle 15–20 mm into the tissue, “that leaves very little room for error if the needle breaks. “I met one dentist who used a 30-gauge extra-short needle for an inferior alveolar nerve block injection,” Woolson recalls. “An extra-short needle is only 10 mm long. That means this dentist not only advanced the needle to the hub, but had to compress the patient’s tissue enough to permit the needle to be injected even further. Imagine the discomfort for the patient!” And, if the dentist inadvertently breaks a short or extra-short needle during an inferior alveolar nerve block, he or she may need to surgically remove it. To do so would cause scarring on the patient’s neck, not to mention a lawsuit, he points out.

“Years of clinical research shows there is no perceptual difference between a 25-, 27- and 30-gauge needle when inserted into the oral tissues,” says Malamed. “Yet dentists persist in using 30-gauge short and ultra-short needles for all injections, including the inferior alveolar nerve block.” In fact, over half of all needles sold to dentists in the United States are 30-gauge, he points out. “I’d love to see them use 27-gauge long and short needles, but after 43 years of teaching and preaching, I’m running short on hope in this regard.”

“Offering a new technology that provides profound anesthesia without the need for injection should be well received by both doctors and patients.”


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Reaching out to customers Reps can initiate a discussion about pain management by asking a few probing questions: • “Doctor, have you ever had a patient faint during an injection?” • “Do your patients ever ask you if you have to give them a shot in order to do a procedure? Do they ever confess that they hate getting shots, but once they are numb they’re okay? These patients are prime candidates for needleless nasal spray for their planned treatment involving maxillary non-molar teeth.”

The cost of new technology may be a factor to the dentist, but it shouldn’t be, says Malamed. “I am perplexed at how a dentist can quibble over the cost of new technologies that enable him or her to provide better quality pain control, more easily, more comfortably and with increased safety. Yet they do. Yet these very same doctors will spend many thousands of dollars buying lasers, intraoral TV cameras and other truly expensive technology that, in many cases, cannot be used without the dentist first achieving effective pain control. “To paraphrase the old Mastercard advertisements: What is it worth to be able to provide your patients with pain-free dentistry using, for example, a needleless technology, when the two most important items in a patient’s shopping list for a ‘good dentist’ are, ‘I don’t want to be hurt’ and ‘a painless injection?’ It is truly priceless.”

Buffered anesthetic For many patients, the worst part of a dental procedure is the initial injection of the anesthetic. A fear of the needle – together with their concern that the numbness might not last and they’ll experience great pain – presents a challenge for dentists, whose goal is to provide an optimal patient experience. Indeed, a common misconception among patients is that the stick of the needle is the biggest source of pain when, in fact, the bulk of pain comes from the anesthetic itself. “Local anesthetic is very acidic, with a pH level as high, if not higher than that of citric acid,” says Ryan Vet, vice president of marketing, Anutra Medical. Consider getting injected with lemon juice, he points out. “No wonder it burns!” One solution is the Anutra Local Anesthetic Delivery System, notes Vet. “By utilizing buffered anesthetic from the Anutra Local Anesthetic Delivery System, practitioners are able to inject local anesthetic at an acidity level that mirrors that of the patient’s body,” he continues. Some patients have even commented that they were unaware of receiving the shot, he adds. Additionally, whereas only twothirds of patients typically reach pulpal anesthesia after the first injection of anesthetic, with buffered anesthetic, “the majority of patients get numb the first time,” he says.

“Utilizing buffered anesthetic helps the anesthetic take effect – on hard-to-numb patients as well as during nerve blocks – often in two minutes or less,” says Vet, providing dentists with as much as 15-20 minutes for each restorative procedure they perform. For dentists who perform as many as 20 or more cases each week, they may gain an extra hour or two in a typical day, he points out, offsetting the higher expense for dentists purchasing a premium anesthetic such as Anutra. Buffered anesthetic is far more reliable than traditional anesthetic, says Vet. This means fewer bail-out shots. Anutra is also more predictable, making it possible to schedule shorter appointment times and schedule more efficiently. Buffered anesthetic is more profound than traditional local anesthetic, allowing dentists to use less volume than they traditionally would have. Additionally, with the multi-dose Anutra Syringe, dentists are able to deliver the precise amount of anesthetic required, eliminating waste. This means the dentist is no longer confined to a 1.8 mL carpule. Most importantly, Anutra helps ensure peace of mind for patients, making their experience in the chair a positive one.

First Impressions

February 2018


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Indicated for all cementation applications except veneers, this self-etching, self-adhesive cement is available in A2 and translucent shades and is dispensed from a syringe for easy placement. Practitioners can rely on one cement and reduce inventory and waste. The cement is dual cure and excess is easily removed after tack curing for one to two seconds. Dentists who prefer to use a bonding agent are free to do so. ACTIVA BioACTIVE-CEMENT is resin-based and works well with all bonding agents. This does not stop the bioactive properties of ACTIVA. The bonding agents are permeable, and the bioactivity reaches equilibrium after several weeks. Patients are increasingly informed about healthcare options, and this includes dental health. Considerable information is available to the public online. Patients want to know that their dentists and healthcare providers are up to date with the latest developments and techniques. For practitioners, explaining the

Mineral Apatite Formation SEM Analysis of ACTIVA™ BioACTIVE-CEMENT™ Surface after 21 Days in Saline Compared to the no saline control, scanning electron microscope (SEM) imaging and energy-dispersive X-ray spectroscopy (EDS) after 21 days in saline shows significant increase in calcium and phosphorus ion concentrations, and decrease in carbon and silica ions, indicating that mineral apatite deposits are forming on the surface.

Fig 1 ACTIVA BioACTIVE-CEMENT Control, no saline 3000x

Fig 2 ACTIVA BioACTIVE-CEMENT 21 days in saline 3000x

Dentists may have crowns come off or see wash-out and recurrent caries at crown margins. This can be avoided with ACTIVA. The cement is insoluble and will not wash out, and apatite formation connects the cement to the tooth with crystalline mineral structures, which aids in retention and continuously rebuilds itself over time.


February 2018

First Impressions

benefits of bioactive materials to their patients is a practice-builder and shows their commitment to patient education, prevention and overall health. ACTIVA BioACTIVE products are the first in a new generation of durable, esthetic, bioactive dental materials that play an active role in maintaining oral health. Continued advances in bioactive materials should be expected from Pulpdent’s research laboratories.

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Respiratory hygiene and cough etiquette in the dental practice


Infection control principles and practices are in-

tegral to the practice of dentistry and the provision of safe patient care, as well as to the dental team members’ health. In general, transmission of bloodborne pathogens (BBP) in the dental setting is rare, but this should not minimize the importance of consistent protocols for reducing the risk of cross-contamination. In 2016, researchers reviewed the literature from 2003-2015 to identify published reports on the transmission of BBP in dentistry. They found the following cases:


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First Impressions

• Patient-to-patient transmission of hepatitis B in an oral surgery practice, where the suspected cause of transmission was inadequate cleaning of environmental surfaces. • Multiple procedural infection control breaches at a free dental clinic, resulting in three patients and two volunteers acquiring hepatitis B. • Patient-to-patient transmission of hepatitis C in an oral surgery office, where there were many lapses in infection control.1 The emphasis tends to be on reducing the risk of BBP transmission, but in another case report, a dental hygienist working in a practice in Washington developed active tuberculosis (TB) and transmitted it to a co-worker. TB is passed through airborne transmission, where droplet nuclei can remain suspended in the air for many hours.2 According to the report, the dental practice had no personnel policies or administrative procedures in place

Respiratory hygiene and cough etiquette are sometimes overlooked or minimized in the dental practice. However, especially now, when we are in the midst of cold and flu season, this is very important. for baseline TB screening or education. In addition, there were no records documenting whether dental staff members received baseline education about the signs and symptoms of TB.3 The risk of acquiring varied diseases or conditions as a dental healthcare worker is always present.

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

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February 2018


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

The practice should have facial tissue, waste baskets and alcohol-based hand sanitizers available to patients in the reception area. Especially at this time of year, the recommendation to offer masks to coughing patients and providing space to separate these patients from others in the reception area is an excellent one.

Key recommendations for respiratory hygiene/cough etiquette in dental settings 1. Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing throughout the visit. a. Post signs at entrances with instructions to patients with symptoms of respiratory Infection to– i. Cover their mouths/noses when coughing or sneezing. ii. Use and dispose of tissues. iii. Perform hand hygiene after hands have been in contact with respiratory secretions. b. Provide tissues and no-touch receptacles for disposal of tissues.

c. Provide resources for performing hand hygiene in or near waiting areas. d. Offer masks to coughing patients and other suymptomatic persons when they enter the dental setting. e. Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible. If available, facilities may wish to place these patients in a separate area while waiting for care. 2. Educate DHCP on the importance of infection prevention measures to contain respiratory secretions to prevent the spread of respiratory pathogens when examining and caring for patients with signs and symptoms of a respiratory infection.

CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care, 2016; pg.9.


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who may have undiagnosed respiratory infections, as well as any dental team members with signs and symptoms of cough or congestion.7 The strategies for implementation of this element of standard precautions is outlined below in the key recommendations from the CDC and is easily accomplished in practice. The CDC’s Key Recommendations include two specific to dental settings. The first focuses on ensuring the practice has the appropriate protocol and armamentarium for patients, or individuals accompanying patients, who

have evidence of respiratory infections. The practice should provide these persons with the necessary items and notices to ensure they are queued upon entering the practice. The reception area should have signage reminding patients to cover coughs, use and dispose of tissues, and perform hand hygiene. The CDC has downloadable posters on covering coughs for reception areas that are informative and suitable for framing.8 The practice should have facial tissue, waste baskets and alcohol-based hand sanitizers available to patients in the reception area. Especially at this time of year, the recommendation to offer masks to coughing patients and providing space to separate these patients from others in the reception area is an excellent one. This demonstrates the practice’s commitment to reducing the spread of respiratory infections to others, and patients and guests will definitely be appreciative of these efforts. The second key element emphasizes the education of dental healthcare personnel on the importance of containing and preventing the spread of respiratory pathogens during the provision of dental care.7 It is vital that all team members are on the same page and understand the rationale for sound infection prevention measures to reduce the risk of acquiring respiratory infections and cross-contaminating patients. All elements of standard precautions play a significant role in preventing disease transmission to patients and dental team members. While there is a tendency to focus on items such as hand hygiene and PPE, the recommendations for integrating respiratory hygiene and cough etiquette into the dental setting are vital to complete the entire picture in promoting patient and staff health. References:

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

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

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February 2018




Chris Jablonski

Reaching New Heights A career in the Air Force prepared From the time he was small, Chris Jablonski had his sight set on the Chris Jablonski to address heavens. Short of being born with his own set of wings, the future Henry Schein Dental sales rep grew up in a family with strong ties to the United States Armed challenges, both personal and in Forces – a calling he could not dismiss. “Both of my grandfathers served, as the dental practice. well as two of my uncles,” he says. In addition, his father is a longtime pilot. 62

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Starting with the basics It appeared Jablonski’s Basic Military Training would provide exactly the structure he sought. “My sole duty was to learn my new job,” he explains. In late December 1994, he flew out to Lackland Air Force Base in San Antonio, Texas. Following his basic training, he transferred to Sheppard Air Force Base in Wichita Falls, Texas, for Basic Undergraduate Aircrew Training. Next, he moved to Keesler Air Force Base in Biloxi, Miss. for an airborne early warning systems apprentice course (a system designed to detect aircraft, ships and vehicles from long ranges). From there, he transferred to Tinker Air Force Base in Oklahoma City, Okla., where he worked as an airborne surveillance technician on the E-3 Sentry Airborne Warning and Control System (AWACS) (an aircraft developed by Boeing, designed to provide all-weather surveillance, command, control and communications). “Tinker AFB was my first proper duty-station following techschool in Mississippi,” says Jablonski. “I was newly graduated from my initial technical training and had finally regained my freedom following four months of highly regimented military training.” While saying his goodbyes to friends, however, a horror was unfolding on national news. Timothy McVeigh had just detonated the Alfred P. Murrah Federal Building in Oklahoma City. “We watched footage of the aftermath of this unprecedented attack on a relatively low-profile city in the heart of America – a city I was heading to the next day,” he recalls. “It was scary to arrive on a military installation in THREATCON DELTA – the highest level of defensive posture a military base could have at that time,” he continues. Indeed, in the days to follow some of new arrivals were called to perform recovery efforts at the bombing site. “I was so young, it was difficult for me to understand the motivation for the attack or the impact it would have on the future of America,” he says.

The unimaginable

“I loved airplanes as a kid, and naturally I loved military aviation,” he notes. “My dad and I were active in Civil Air Patrol (CAP) – a cadet program for 12-19-year-olds that fosters leadership skills through activities such as flying, search-and-rescue, hiking and camping – from sixth through ninth grade, which brought me even closer to joining the Air Force.” Unsure of what to pursue in college, he decided to take his dad’s advice and join the Air Force. “My dad reminded me that my Billy Mitchell Award from CAP would earn me a two-stripe promotion right after basic training, so I joined,” he recalls – a move that shaped the next 22 years of his life.

If moving to a city in crisis was a sobering experience for Jablonski, the years to follow proved equally challenging. While in Oklahoma City, he met – and married – his first wife, Davida. Her mental health issues, compounded by multiple moves in the Air Force, however, led to tragedy. “While in Oklahoma City, I deployed twice to Saudi Arabia to enforce the Southern No Fly Zone in Iraq,” he says. Then, in 1997, I was off to Elmendorf Air Force Base in Anchorage, Alaska. He and Davida moved again, in 2000, to Robins Air Force Base in Warner Robins, Ga., followed by a move in 2004 to Hurlburt Field Air Force Base in Okaloosa County, Fla. During this time, Davida’s illness progressed steadily. “The emotional strain of dealing with a family member’s mental illness is indescribable, not to mention the effects of stress, combat and trauma, which, at that time, were still being

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February 2018



“I was 2 flights away from my check-ride, which is a final exam for flyers, when I learned of Davida’s death,” Jablonski recalls. “The director of operations pulled me out of a mission briefing and took me to my commander, who – together with a chaplain and a few other people – notified me of her passing. I experienced every possible emotion before grounding myself and asking about what would become of my training. I was so close to finishing.” In the weeks that followed, Jablonski and his daughter attended Davida’s funeral; cleaned out her storage unit, filled with “10 years of memories and junk;” and received counseling. “We attempted to manage without effectively grieving,” he says. “I was Mr. Fix-It. Once we got through the stuff that needed to be done, it was important that I get back in the plane and finish my training – a job I started 2 ½ years earlier, and then restarted twice more. Unfortunately, I never realized that, and I was bitter and defeated for years to come. Looking back, though, it was for the best. I was in no shape to properly discharge the duties of that position. “Luckily, I had a few very close friends and a family who loved me,” he continues. In late 2007, he met his wife-to-be, Heather. “As we started to build our life together, I gathered myself and managed to squeak through training for a different crew position on the same type of aircraft,” he says. “It was tough, and it wasn’t pretty, but it was progress.” In the end, he did become Chris Jablonski and wife, Heather an Air Commando, he adds.

researched,” says Jablonski. And, when one is stressed out and in over his head, he tends to be the last one to notice, he adds. “I just kept going. I thought, ‘This is life: You go to work, you try your best, you keep the family stuff going and maintain a level head.’ I didn’t think it could get worse, but it did. My duty performance slipped steadily downward.” Again and again, his supervisors would ask him why he hadn’t come to them sooner for support, he recalls. “I guess I didn’t know what an abnormal life looked like, so I just kept on going.” Eventually, Jablonski and Davida divorced. By then, however, they had a young daughter, Cailey. Less than two years following the divorce – when Cailey was seven years old – Davida took her life. “The divorce and having to begin anew had

“I got to skydive with the U.S. Army Golden Knights, shake the hand of a sitting U.S. president, and see three presidents and one vice president speak. I flew over Mt. McKinley in Alaska, got to go camping (Arctic Survival School), visited a mall in Doha, Qatar, and went snorkeling in the Caribbean, off Isla Grande in Panama.”

been hard enough,” he says. This was unbearable, he notes. Although his mother helped tremendously by selling her home in Pennsylvania and purchasing a home in Florida, where he was stationed at the time, Davida’s death “was too much to recover from,” he says. “At the same time, I was completing the most grueling training I’d ever endured,” he continues. Jablonski was training to become an Air Commando – a program that was “physically, emotionally and mentally more challenging than anything I’d ever attempted,” he says. “The successful completion of Air Force Special Operations training requires optimum health, mental toughness, absolute focus and a stable home-life.” During that time, however, he required major back surgery for a blown disc, surgery for a broken leg following his divorce, and the death of Davida.


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A new beginning Jablonski and Heather married in 2009, at which time he took a non-flying position in the Air Force. After two six-month deployments within a three-year period, he applied for a position as First Sergeant. “While waiting for my training to begin, I received about a year of intense on-the-job training. I finally went through the Air Force First Sergeant Academy, where I met Jason McKinley – at that time a Henry Schein Equipment and Technology Specialist in Arkansas. (McKinley has since moved on to a large manufacturing partner to assist with product development.) “I met Jason on the way to the military clothing sales store on a neighboring base in Alabama,” Jablonski continues. “We had been sitting next to each other in class for about two weeks, when he asked me, ‘Hey man, so when are you gonna retire?’” Taken aback, Jablonski really had no idea what his future held.

“Then Jason asked me what I planned to do when I retired, and I told him I might go back to school for psychology and become a counselor. That’s when he said, ‘Dude, you need to do what I do. You’d absolutely kill it in sales!’” At first Jablonski was skeptical that he could excel in sales with no prior experience. Heartened by McKinley’s reassurance, however, he agreed to consider it. “Three years later, I called Jason and he recommended I submit my resume. Although my resume showed a strong focus on operations and human resources, I submitted it and eight interviews later secured a job as a rookie field sales consultant. To borrow a line from McDonald’s – I’ve been lovin’ it ever since!” And as it turns out, Jablonski’s Air Force training did, to some extent, prepare him for a sales career. “I worked with some brilliant people and incredible leaders in the Air Force, including both officer and enlisted personnel, sister service members and international military partners. I learned to talk to people in all walks of life, helping them complete a mission or address a challenge. As in my role as a field sales consultant, my Air Force relationships were consultative, not just transactional. “I also took several leadership courses (I was the top graduate in Airman Leadership School), including a John Maxwell seminar, which taught me to better communicate/work with different personalities. Most important, though, was my training and experience as a First Sergeant. Most people don’t understand the role of First Sergeant, who is the commander’s trusted advisor on all matters affecting the enlisted force, especially morale, health, welfare and discipline. The First Sergeant makes sure the commander has a fit and ready force and is prepared to meet any challenge in a moment’s notice.” So, when it comes to working with his dental customers and helping them make decisions that could impact the long-term direction of their practice, Jablonski is a natural!

“I worked with some brilliant people and incredible leaders in the Air Force, including both officer and enlisted personnel, sister service members and international military partners. I learned to talk to people in all walks of life, helping them complete a mission or address a challenge. As in my role as a field sales consultant, my Air Force relationships were consultative, not just transactional.”

Then and now His experience in the Air Force will always hold special memories for Jablonski. “I got to skydive with the U.S. Army Golden Knights, shake the hand of a sitting U.S. president, and see three presidents and one vice president speak,” he says. “I flew over Mt. McKinley in Alaska, got to go camping (Arctic Survival School), visited a mall in Doha, Qatar, and went snorkeling in the Caribbean, off Isla Grande in Panama.” He most enjoyed being engaged with those around him, he recalls – whether he was

helping someone in crisis, speaking publicly (He delivered the invocation at the Gold Star Mothers Ruck March fundraiser), motivating a colleague or applauding someone’s accomplishments. And, despite his share of personal struggles during his years in the Air Force, Jablonski has some fond memories of his first wife and was blessed with the birth of his daughter, and remains grateful for Heather coming into his life and the birth of their son, Christopher. Looking ahead, he anticipates “watching the dental practices I work with flourish and thrive,” he says. “I know these dentists will be successful because Team Schein has equipped them with the right knowledge and tools.” As a result, he adds, he can trust that “we’ve helped make going to the dentist a positive experience” for children and families.

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February 2018



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 Private label, Amazon style AmazonBasics leads Amazon’s private brand sales, with over $400 million (as of Dec. 20, 2017) in estimated sales, or 85 percent of total Amazon private brands sales in the United States, according to e-commerce analytics firm One Click Retail. Due to a strong performance of both Pinzon (bath, bedding goods, etc.) and AmazonBasics, Amazon’s Home product group – which was expected to achieve over $80 million in 2017 sales – surpassed its Electronics product group, estimated at less than $70 million. The Amazon Elements line of baby wipes continues to be a suc-

added to the chain to complete the transaction. Blockchain uses cryptography to secure exchanges and provides a digital ledger of transactions that are transparent, reportedly reducing the risk of fraud and preventing transactional duplication.

Cellphone radiation California’s new cellphone safety guidelines for adults and children are being welcomed by the public health, environmental and First Amendment advocates. The guidelines echo a Berkeley City Council action in May 2015, which approved a cellphone disclosure ordinance that obligates vendors to warn buyers that carrying the devices close to the body could expose them to excessive radiation. The state guidance advises consumers to, among other things, keep cellphones away from their head and bodies during the day and their beds at night, as well as avoid using cellphones when streamlining audio or video or downloading or sending large files.

Blockchain technology was initially developed to facilitate the exchange of cryptocurrencies without the need of a middleman, like a bank, to make a transaction. cess, nearly doubling its 2016 estimated sales with a growth of 94 percent year-over-year. The estimated >$15 million sold in 2017 in baby wipes alone makes up the majority of the Amazon Elements brands, supplemented by just over $1 million in estimated sales of vitamins and supplements. Since September 2017, Amazon has launched several new private brands, according to One Click Retail: Rivet (consumer rugs and living room furniture); Stone & Beam (premium rugs, sofas, lamps and fixtures); and Goodsport, Peak Velocity and Rebel Canyon (activewear and sports apparel).

A new term to learn: Blockchain Though typically associated solely with bitcoin and cryptocurrency, blockchain technology is becoming increasingly important for a wide range of industries – from oil & gas to security and sports betting, according to NetworkNewsWire. Blockchain technology was initially developed to facilitate the exchange of cryptocurrencies without the need of a middleman, like a bank, to make a transaction. In this system, every transaction is represented online as a block, which is distributed to a network of computers for approval before being


February 2018

First Impressions

A decentralized ISP Open Garden wants to make it easy for anybody with an Android phone to share their Wi-Fi connections with anyone who is nearby, reports TechCrunch. To incentivize people to do so, the company plans to launch its own Ethereum token in early 2018. The company bills this as the launch of a “decentralized Internet Service Provider (ISP).” The rationale is that most people use only a small amount of their broadband connection’s bandwidth cap. So why not share this access with others and earn some OG in the process? While Open Garden argues that this is a totally new concept, the likes of Fon and others have long enabled W-Fi sharing without the need for Ethereum tokens and mesh networks. Most have done so with mixed success, likely because few people actually want to share their Internet access. Open Garden is trying to jumpstart the process of building participation by using its FireChat app to bootstrap this process. The company says its messaging service has over 5 million registered users and they will form the basis for seeding this network. Over time, Open Garden also plans to add apps for iOS, Mac, Windows and set-top streaming boxes.


Industry News Suzanne Swan joins NDC Specialty Markets Team NDC announced Suzanne Swan as the newest member of the NDC Specialty Markets Team beginning January 2, 2018. Suzanne will manage NDC’s dental members (East territory) and the full roster of Physical Rehab members. With over fourteen years of experience working with dental distributors from the manufacturer perspective, Suzanne’s management and strategic marketing experience will be an asset in driving sales results.

“With her core strengths as an achiever, strategic planner and communicator, Suzanne is an excellent addition to our team. We are excited to welcome her to the NDC team”, says Lori Paulson, VP, Dental & Specialty Markets. Suzanne holds a Bachelor’s Degree in Exercise Science and will bring this knowledge to the physical rehab market segment.

Benco Dental Appointee Announcements Jeremy Avery Territory Representative Benco Dental is pleased to welcome Jeremy Avery to its Cascade region. Avery brings five years of dental sales experience to the Benco family in the Pacific Northwest. Tommy Bruneau Territory Representative Tommy Bruneau joins Benco Dental in the New England region. Bruneau studied business at Westfield State University. He brings four years of dental industry and sales experience to Benco customers in his region. Amy Colwell Territory Representative The Benco Dental team in the Susquehanna region welcomes Amy Colwell. Colwell earned a Bachelor of Science in Business Administration from the University of Nebraska-Kearney. She brings six years of sales and service experience to Benco. James Contento Territory Representative James Contento joins Benco Dental in the Liberty region. Contento brings 17 years of dental industry and sales experience to the Benco family.

Thomas M. Decker Territory Representative Benco Dental is pleased to welcome Thomas M. Decker to its Ohio Valley region. Decker brings 22 years of dental industry experience to his new position and to Benco customers in the Ohio Valley region. Jesse L. Horn Territory Representative Jesse L. Horn joins Benco Dental in the Trailblazer region. Horn studied at Ohio State University and brings four years of dental industry and sales experience to Benco customers in his region. Carolyn Hoyt Territory Representative The Benco Dental team in the Desert region welcomes Carolyn Hoyt. Hoyt, a graduate of Gateway College, brings eight years of dental industry experience to Benco. Allison Jones Territory Representative Allison Jones joins Benco Dental in the Bay region. Jones earned her Bachelor of Arts degree in Organizational Communications from California State University, Chico. Jones brings nine years of sales experience to the Benco family in California. (Continued on next page)

First Impressions

February 2018



Robert Krug Territory Representative Benco Dental is pleased to welcome Robert Krug to its Cascade region. Krug, a U.S. Army Veteran, brings four years of dental sales experience to the Benco family.

Jill Petroff Territory Representative Benco Dental is pleased to welcome Jill Petroff to its Ohio Valley region. Petroff, who studied at Ohio University, brings 15 years of dental industry and sales experience to the position.

Ed Moore Territory Representative Ed Moore joins Benco Dental in the Cascade region. Moore earned a degree in Journalism and Government from Eastern Washington University. He brings 10 years of dental industry and sales experience to the Benco family.

Alexander Stoyanoff Territory Representative Alexander Stoyanoff joins Benco Dental’s team in the Ohio Valley region. Stoyanoff earned a degree in Public Relations from Slippery Rock University. He brings four years of related experience to the Benco team.

Michele Peabody Myers Territory Representative Michele Peabody Myers joins Benco Dental in the SoCal region. Peabody Myers, a Certified Dental Assistant, earned degrees from Long Beach City College and School of the Art Institute of Chicago. She brings nine years of dental industry and sales experience to the Benco family.

David Vicars Territory Representative The Benco Dental team in the Peachtree region welcomes David Vicars. Vicars brings 20 years of dental industry and sales experience to Benco customers in the Peachtree region.

Henry Schein Appointee Announcements Mia St. Martin, Digital Technology Specialist Mia will represent Henry Schein Dental in the New Orleans, Louisiana area. She has nine years of experience in the dental field.

John Gonzalez, Digital Technology Specialist Gonzalez will be representing Henry Schein Dental in the Miami/Ft. Lauderdale, Florida area. He is new to the dental field and previously worked for CocaCola as a district sales manager.

Brad Veazey, Digital Technology Specialist Brad will be representing Henry Schein Dental in the Mobile, Alabama region. He is new to the dental field and his previous employers include Hospira and Coloplast.


February 2018

First Impressions

Chad Williams, Field Sales Consultant Chad will continue to represent Henry Schein Dental in the Seattle, Washington area, after six years of previous experience as a service dispatcher and inbound sales representative.

Max Scheinberg, Field Sales Consultant Scheinberg will be representing Henry Schein Dental in the Orlando, Florida region. He is new to the dental field and previously worked as a sales representative for BioPlus Specialty Pharmacy.

Jason Minatrea, Digital Technology Specialist Minatrea will be representing Henry Schein Dental in the Nashville, Tennessee region. He is new to the dental field and previously worked as a technical sales representative for Weatherford International.

Tracey C Earls, Field Sales Consultant Tracey will be representing Henry Schein Dental in the Atlanta, Georgia region. She previously spent 21 years as a registered dental hygienist and then three years as a territory sales manager for a distributor.

Todd Smith, Field Sales Consultant Smith will be representing Henry Schein Dental in the Grand Rapids, Michigan. He previously spent five years as a territory manager for a distributor.

Adana Wheeler, Field Sales Consultant Wheeler will be representing Henry Schein in the Tampa, Florida region. She has 31 years of experience in the dental field, 10 of which she spent with Henry Schein as a digital technology specialist.

Mike Kemper, Field Sales Consultant Kemper will be representing Henry Schein Dental in the Indianapolis, Indiana region. He has 15 years in the dental field.

David Sheets, Equipment Sales Specialist David will be representing Henry Schein Dental in the Portland, Oregon region. She has 16 years of experience in the dental field.

Steven Kliegman, Field Sales Consultant Kliegman will be representing Henry Schein Dental in the Baltimore/Washington region. He has 26 years of experience in the dental field.

George T. Gibson, Regional Manager Gibson will be representing Henry Schein Dental in the Louisville, Kentucky region. He has 17 years of experience in the dental field.

Greg Earls, Field Sales Consultant Greg will be representing Henry Schein Dental in the Atlanta, Georgia region. He has 25 years of experience in the dental field.

Rich Ballon, Digital Technology Specialist Rich will continue to represent Henry Schein Dental in his new role in the Chicago area. Rich has 21 years of experience in the dental field, 9 of which he spent working as an equipment sales specialist for Henry Schein.

Robert Meeks, Field Sales Consultant Roberts will be representing Henry Schein in the Indianapolis, Indiana region. He has 34 years of experience in the dental field.

Dr. Paul Kennedy, Professional Practice Transitions Consultant Paul Kennedy, DDS has joined Henry Schein Professional Practice Transitions (Henry Schein PPT) as a Dental Transitions Consultant covering the state of Washington. In this role, Dr. Kennedy will help dentists transition their practices to new owners in a way that achieves their personal and business goals, while at the same time caring for the patients and staff that are part of their legacy. Paul joins Henry Schein with more than 12 years of experience owning and growing his own dental practice. Paul received his Doctor of Dental Surgery Degree from the University of Washington School Of Dentistry in Seattle Washington. He also received his Bachelor of Science degree in Biology there.

First Impressions

February 2018



Patterson Appointee Announcements


Mark Anderson

April Dorris

Scott Drysdale

Whit Gaddy

Paige Geweke

Mellissa Hammett

Kelly Hawkins

Tisha Head

Marta Korchemniy

Amy Lufkin

Sandra-Jane Mancini

Valerie Mika

Shane Miller

Sarah Morrison

Robert Phillips

Nickole Ragsdale

Shanda Sentmore

Destiny Studzinski

Christina Swanson

Christine Tremblay

George White

Stephanie Wood

February 2018

First Impressions

Tetric Evo Line ®

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



To replace these faulty amalgams Dr. Sesemann utilized Adhese Universal and Tetric EvoCeram Bulk Fill to efficiently place adhesively sealed direct composite restorations.

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