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Apple Vision Pro - Is Dentistry Ready?

From what I experienced and learned about the headset, we can see 3 possible scenarios of this technology being adopted in dentistry. 

Published:
February 19, 2024
By:
Tiger
Safarov
we are launching ZenOne in Texas
So why are we launching in Texas first?

We are so excited to announce to the dental world that we are soon launching our new product, ZenOne. First, only in Texas and to a small group of practices who love the thrill of being first and are up for an adventure. So let’s dive in why Texas is our first State to launch a new product.

Published:
January 31, 2024
By:
Tiger
Safarov
blog post
Richard Markules, Garrison Dental Solutions

Listen to the podcast here Watch the full video on Youtube Trip to Michigan At Zen, we really love when we have an opportunity to go out and meet the people we work with. A recent visit to Michigan brought us together with Rich, the Head of North America Sales at Garrison Dental, and it was truly special. This meeting marked a pivotal moment in our journey, as both Rich and I dedicated significant time to brainstorming and developing strategies aimed at elevating our partnership. Our shared mission, which has always been the primary goal of our respective companies, remains focused on helping private practices get top-notch products while having direct relationships with manufacturers. Rich’s background Rich, with 17 years at Garrison Dental, joined the company when it was a decade into its existence. He initially stepped into the role of a sales manager, entrusted with the task of establishing the sales group for North America. At that time, there were only two customer service representatives who laid the foundation for the inside sales department at Garrison Dental Solutions. Before his tenure at Garrison, Rich's professional background was firmly rooted in the banking and mortgage industry. He had managed large call centers across the United States, overseeing various financial services, including credit card processing and mortgages. His transition to Garrison Dental coincided with a turbulent period in the banking industry, marked by a housing market crash and economic instability. Despite the uncertainty in the banking sector, Rich seized the opportunity to start working in the medical field. A friend who was a recruiter guided him toward the position at Garrison Dental, and though he had reservations about the unfamiliar territory of the dental industry, he took a leap of faith. Garrison Dental was a relatively small company at the time, but it held grand ambitions for growth. What drew Rich to the company was its strong family-oriented culture, a refreshing departure from the corporate world where he had previously worked, characterized by a disconnect between employees and company owners. The welcoming atmosphere and close-knit environment at Garrison Dental were particularly appealing to him. Early years of Garrison Dental Right next to the manufacturing facility, there's a dental office that holds a special place in Garrison Dental's history. This dental practice had a unique role in the company's origin story. It all began in the basement of this building, where Dr. Edgar Garrison ran his dental practice. When Dr. Edgar Garrison retired, his son, John, took over the practice, maintaining the family tradition of dentistry. While John was practicing upstairs, the foundation of Garrison Dental Solutions was laid in the basement. About eight years later, they moved into the building that still houses Garrison Dental today. In the early days, Garrison Dental outsourced a significant portion of their manufacturing. However, a transformation occurred over the years, and now the majority of their manufacturing takes place at their in-house facility. Innovative product For Rich, the knowledge that Garrison Dental manufactured its own products instilled a deep sense of confidence in the products he sold. During his early days with the company, he attended a trade show and noticed a great interest from customers. Many visitors flocked to the Garrison Dental booth, eager to see what was new. This demand often led to increased sales, a testament to the innovative product lines and the strong loyalty of their customer base. Rich found it surprisingly easy to promote their product line, given the reputation of Garrison Dental and its commitment to innovation. In the past, when Rich first joined, many dental practitioners were using older methods, such as the Tofflemire matrix system. This required a more detailed and technical sales process, explaining the advantages of the sectional matrix system. Today, the landscape has evolved. Approximately 70% of dental practices have transitioned to using sectional matrix systems for their restorations, making the sales process less technical. The focus now lies in highlighting the superiority of Garrison Dental's products over their competitors. While there are still some Tofflemire users, the process of explaining the benefits has become more streamlined and focused on product differentiation. Shift in the dental industry Nowadays, Rich believes the most significant change in the dental industry is the shift from solo practices to a more corporate landscape. When he first joined the field, solo practitioners were the norm, often passing their practices down through generations. An example of this traditional model was the Garrisons, where three generations of dentists - Edgar's father, Edgar, and John - continued the legacy. However, in the present day, there is a notable trend toward corporate entities known as DSOs (Dental Support Organizations). This transition away from solo practitioners passing practices down to their children to a more corporate structure has reshaped the industry. While Rich recalls that Heartland Dental was one of the pioneering DSOs when he started with Garrison, this corporate model has since become more prevalent. Regarding what makes a private dental practice strong and resilient, Rich believes it's much like any successful business. The key lies in the relationships they build within their community and the devoted followers they accumulate. An example close to home is Spring Lake, Michigan, where practices like Ed Crenshaw Garrison's were deeply intertwined with the community. The positive impact they had on their local area contributed to their strength and success. In Rich's view, this community-oriented approach is not only a blessing but also the essence of how business should be conducted. Online business operations Rich believes that the landscape of the dental industry is continuously evolving. Notably, there has been a significant shift towards online business operations. The growth of online sales and e-procurement is becoming increasingly prominent, much of it influenced by giants like Amazon. With the changes brought about by COVID-19, the role of dealer representatives visiting dental practices has dwindled. The industry is embracing more online processes. Rich also stresses the importance of partnering with organizations that share similar values. Garrison Dental takes pride in offering their products through multiple channels, including e-procurement and direct dealers, with a strong focus on catering to the needs of the customer. The key is to collaborate with partners who share the same vision and commitment to customer care. In their interactions with dental practices, Rich and his team often encounter the challenge of staff turnover. They understand that practices undergo personnel changes, and it can be stressful for the doctors. Rich highlighted that they offer webinars and online resources to help new team members become acquainted with Garrison's products, especially if they're unfamiliar with them. This support ensures a smoother transition for the practice and its staff. Rich also emphasized the impact of COVID-19 on the industry and how Garrison Dental adapted to the changing landscape. In response to the limitations imposed by the pandemic, Garrison Dental elevated its commitment to educational technology. They began producing webinars and other online resources that allowed customers to see their products in action during various dental procedures. These resources were a direct response to the absence of trade shows in 2020 and 2021, which traditionally provided an opportunity to meet customers in person and showcase products. With the shift to online resources, customers could now easily access instructional material by visiting Garrison Dental's website or YouTube channel, enabling them to gain a better understanding of product usage. Final Words In conclusion, at Zen, we are grateful for the opportunity to collaborate with Garrison Dental Solutions. In our interactions with the team, we emphasize our commitment to learning and doing things the right way. Every time Rich and Tiger connect to discuss ways to work together, the central question is, "How do we best serve the customer?" This guiding principle helps them refine their internal processes and continually improve their collaboration. We look forward to continuing this productive partnership!

Published:
October 19, 2023
By:
Tiger
Safarov
big-announcement
Big Announcement: From ZenSupplies to ZenOne

Listen to the podcast here Watch the full video on Youtube Dear Zen Members, We launched ZenSupplies in 2016 with a simple goal to streamline the ordering process and help organize the dental world one order at a time. Step by step we made progress and I personally met most of you at conferences or in your office. All of these meetings made ahugeimpact on me and most importantly allowed me to see how Zen was being used in real time in a dental office. It also added a sense of responsibility to build the right product that truly brings value to each one of you. These one-on-one meetings allowed me to learn and deeply understand the challenges of each practice, team dynamics, and how Zen needed to better function in order to solve your problems. As we learned and continued to grow I realized there were decisions I made early on that were holding us back from the potential we were capable of. For example, how we structured catalogs or how order approval processes were made. I can remember many instances when I visited one of your offices and saw how painful it was to use certain parts of the Zen site. I had this growing desire inside of me and I knew Zen could be better and have a platform that every practice would love using. In 2021, I decided it was time to build a new platform from scratch. This would take everything we had learned into account and provide our members with a much better, faster, and more importantly- smoother experience. Prices and stock levels are updated in real time and search is so intuitive that it feels as if a human is listening to you and finding what you are looking for. This new platform would also give us the flexibility we needed to scale to many more vendors and add long-awaited features such as expense management, budget labels, and predictable ordering through integration with your practice management software. I am very excited about the near future and can’t wait for you to see what this new Zen platform can do for your office. We will begin offering demos and a preview of the new platform starting early November into December with a goal of starting migration on January 1, 2024. My team is relentlessly working around the clock to make this process as smooth and easy for each of you as possible. My hope is that you will find the new Zen platform to bring even more efficiencies, a better user experience, and even more amazing savings to your office. Please keep an eye out for email updates and important information as we get closer to the launch date. And please make sure to sign up for a demo. I am confident you will love it! You can reach me attiger@zenone.comand by phone 872-225-2090 or Delaney atdelaney@zenone.comor by phone 872-225-2894. Tiger and the entire Zen Team

Published:
October 19, 2023
By:
Tiger
Safarov
Article Cover - Water
9 Things You Need to Know about Maintaining and Monitoring Dental Unit Waterlines

The Centers for Disease Control and Prevention (CDC) set the water quality standard for dental unit treatment water at ≤500CFU/ml of heterotrophic bacteria. Many dental practices are treating their dental unit water by placing a tablet or liquid in the water bottle or utilizing a valved cartridge (referred to as straws) in the water bottle to control the growth of biofilm and improve water quality. However, many practices assume that the product they use is working and that they are meeting the CDC’s water quality standard. The bottom line is that if you don’t test your dental unit water, you don’t know if you are meeting the standard. These are 9 things that you need to know about dental unit water quality. 1 - Patients can and have developed bacterial infections from contaminated dental unit water. In 2015, 24 pediatric patients at a facility in Georgia developed Mycobacterium abcessus infections from exposure to contaminated water during pulpotomy procedures. In 2016, a similar outbreak occurred in California, involving 71 patients, who were hospitalized to treat the infections. More recently, the CDC issued a Health Alert through its Health Alert Network (HAN) emphasizing the importance of following recommendations for maintaining and monitoring dental unit water quality, based on past incidents and an ongoing investigation of yet another outbreak of infections. None of these outbreaks have resulted in patient deaths, however, 2 patients have died from Legionella infections contracted in dental practices from dental unit waterlines. 2 – Using distilled or filtered water in dental units does not prevent biofilm formation and water contamination. Some dental professionals equate distilled water with sterile water – meaning that it has no microorganisms, that can contribute to the formation of biofilm in the dental unit waterlines. This is not true, however. Whatever type of water is used in the dental unit, something must be done or added to the water to maintain the safe water standard. There are a number of options that dental practices can implement to maintain safe water, including the addition of an antimicrobial tablet or solution each time the water bottle is filled, installing a valved cartridge or straw) into the water bottle, installing a whole-office or point-of-entry water purification system, in addition to utilizing municipal water connected to the dental unit or in a separate water reservoir/bottle. It is very important to consult the manufacturer’s instructions for the use of the equipment to determine the recommended method of treating the water in the dental unit. Waterline disinfectants/maintenance products act to inhibit the growth of bacteria and biofilm formation but do not prevent it. 3 - Surgical procedures require the use of sterile water or sterile saline for irrigation. Due to the risk of introducing microorganisms into a sterile body cavity during surgical procedures, water from the dental unit should not be used to irrigate surgical sites. Sterile water or sterile saline can be dispensed from a sterilized bulb syringe or through the use of a specifically designed sterile water delivery system, that can be sterilized after each use. Placing sterile water or sterile saline into the dental unit water bottle does not ensure that the water is sterile when it exits the dental unit since it is exposed to the biofilm present in the dental unit waterlines. 4 – Most waterline maintenance products require a periodic shock treatment of the waterlines. The manufacturers of dental unit waterline disinfectants/maintenance products have recommendations for a shock or cleaning treatment for the waterlines. The manufacturer of the disinfectant determines how often the shock treatment should be performed which may vary depending on the product used. Shocking involves adding an antimicrobial solution, usually at a higher concentration than the maintenance product, and leaving it in the lines overnight. This procedure will clean the lines and remove biofilm. Some products require three consecutive treatments to clean and remove all of the biofilm that has accumulated. Always follow the manufacturer’s instructions for the use of both waterline disinfectants and shock products – as they are not interchangeable. 5 – If you don’t test your dental unit water, you don’t know if you meet the safe water standard. Although the products used in dentistry to treat and shock the dental unit waterlines have been tested for efficacy, there are many variables that can affect whether the product is working effectively in each dental unit. The only way to assess that the water meets the ≤500CFU/ml standard is to test the water in each unit. Testing the water can be done in-office or mailed to a water laboratory. The CDC states that testing should be performed “periodically”, however, most manufacturers recommend quarterly testing. If the dental units in your facility have never been tested, a best practice would be to test all the units as a baseline. This can help identify any issues with specific units or individual waterlines. If any of the dental units do not meet the water quality standard, the lines in those units should be shocked and then retested. Be sure to record all test results for each dental unit. 6 – There are two ways to perform dental unit waterline tests. The first method is to do a pooled test. This involves dispensing equal amounts of water from all the lines on a dental unit (air/water syringe, handpieces, and scalers) into the test container. The other is to test each waterline individually. Most practices use pooled samples. Testing individual lines is typically performed when the unit continually fails, and further determination is needed to find the source of the contamination. Always follow the manufacturer’s instructions for conducting the test. 7– Dental unit waterline tests are not meant to identify specific microorganisms in the water. Dental unit waterline test kits are designed to determine the number of colony-forming units of bacteria in the water sample. In other words, does the water meet the standard or not. There are some water labs that will analyze the microbial content of the water, but it is usually not necessary for dental facilities unless a specific problem has been identified. 8 – Contaminated dental unit water is also a risk to the dental team. While we tend to think of the risk to patients from exposure to contaminated dental unit water, the clinical team members are exposed to aerosols from that water (and saliva/blood from the patient) during most of the procedures that they perform each day. When dental handpieces, air-water syringes, and ultrasonic scalers are utilized, the aerosols created contain microorganisms that are contained in the biofilm in the lines. If the clinical team is not wearing appropriate personal protective equipment (PPE), they can also be exposed to potential transmission of infectious diseases from the dental unit waterlines. 9 – Dental practices should have written protocols for maintaining and testing their dental unit waterlines. Consistency and accuracy are the keys to achieving safe dental treatment water for patients and team members. Written protocols, or standard operating procedures, help to ensure that each team member knows how to perform waterline maintenance procedures. Keep in mind that not all the dental units in a facility are the same, and different equipment may require slightly different protocols. As previously mentioned, the practice should also maintain documentation of waterline testing and shocking, in order to prove that the procedures have been done and make sure that no units have gone untested or untreated. Dental unit water quality has been in the news a great deal over the past several years. Be proactive about your dental unit water quality by testing and following the recommended procedures for your equipment and the products that you use. Let your patients know that you do your utmost to provide them with safe care – including safe water. CDC Morbidity and Mortality Weekly Report (MMWR), April 8, 2016, Notes from the Field:  Mycobacterium abcessus Infections Among Patients of a Pediatric Dentistry Practice – Georgia 2015. https://www.cdc.gov/mmwr/volumes/65/wr/mm6513a5.htm   CDC Health Alert Network (HAN) Outbreaks of Nontuberculous Mycobacteria Infections Highlight Importance of Maintaining and Monitoring Dental Waterlines https://emergency.cdc.gov/han/2022/han00478.asp   CDC Healthcare Water Management Program Frequently Asked Questions https://www.cdc.gov/legionella/wmp/healthcare-facilities/healthcare-wmp-faq.html

Published:
October 17, 2023
By:
Mary
Govoni
HIPAA Compliance
Eight Common HIPAA Violations in Dental Practices

HIPAA compliance has become normalized in dental practices across the country. In some instances, it is almost taken for granted after 20 years since the first Privacy Rules were implemented. Dental practices are, however, being audited by HIPAA’s parent agency – the Dept. of Health and Human Services (DHHS), and complaints are filed by patients and investigated by HIPAA’s enforcement agency – the Office for Civil Rights (OCR). Since dental practices can be cited and fined for non-compliance and/or violations resulting from audits or complaints, it makes sense to examine the most common violations and strategies to avoid them. 1. Lack of Employee Training All employees, both administrative and clinical, must receive initial training (i.e., when they are hired) as well as annual training updates. Training topics must cover the provisions of the Privacy Rules, Security Rules, and Breach Notification Rules. Training can be provided by a knowledgeable member of the team, an outside consultant/trainer, or through video and online training programs. If a prerecorded video program is used, the employer or practice administrator must plan for answering employee questions regarding the training information presented. A dental practice must keep records of all HIPAA training and will need to produce those records in the event of an audit or complaint. 2. Failure to Document Privacy and Security Policies A key component of HIPAA compliance is a written set of policies and procedures for providing for the privacy and security of patients’ protected health information (PHI). A dental practice can access templates for these policies from the DHHS at https://bit.ly/3ZbpuNY , by working with a HIPAA consultant, or by purchasing a HIPAA compliance manual from various sources, such as the American Dental Association at https://bit.ly/45KmtqE. 3. Lack of Business Associate Agreements Business Associate Agreements are essentially contracts between a covered entity (dental practice) and a business or support service who need to access patient PHI to provide their services. This also includes any contractors that a business associate utilizes to provide services to the dental practice. The purpose of this agreement is to ensure that the business associate provides all necessary safeguards to protect the privacy and security of the dental practice’s PHI. Some examples of business associates are consultants, technology support companies, software vendors, and healthcare claims clearing houses. Information on Business Associate Agreements is available from DHHS at https://bit.ly/489Wri0 or from a HIPAA consultant or a purchases HIPAA compliance manual. 4. The Practice’s Notice of Privacy Practices is not posted The HIPAA privacy rules require that a covered entity/dental practice develop a Notice of Privacy Practices (NPP), which details the ways in which the practice protects the privacy of PHI and how it may be used for Treatment, Payment, and Operation of the practice. This document must be posted in a prominent place where patients have access to it, including on the practice’s website, and a copy must be provided to a patient or parent on request. Since this document is several pages long, it may take up a fair amount of space if it is framed and hung on the wall. An option would be to format the document into a foldable brochure (printed in landscape format) and place it in a brochure holder in the reception area. Copies can also be laminated and available in the check-in area of the front desk. The NPP must indicate the name of the privacy officer/manager, how to contact them, and how to file a complaint. If the person designated as the privacy officer changes, the NPP must be updated. A template for a NPP is available from the Dept. of HHs at: https://bit.ly/44MAm6c. Currently, the HIPAA rules require that patients/guardians sign an acknowledgment that they have been given access to the NPP, which is commonly referred to in practices as the “HIPAA form”. Proposed changes to the HIPAA rules indicate that this may not be necessary when these changes become effective (possibly in 2024). It is important to note, however, that practices should continue to obtain this acknowledgment for now, along with the names of individuals with whom the practice may communicate about the patient’s treatment. This would include spouses, parents of dependent children who are over 18 years of age, and adult children of elderly patients. Parents and guardians of minors always have the right to discuss treatment. 5. Failure to conduct an annual Security Risk Assessment (SRA) This provision of the HIPAA Security Rules is critical to the safety of electronic data in a practice. The purpose of this document is to assess whether there are risks to the security of PHI in the practice, rate the severity of the risk, and develop a strategy and timeline for mitigating those risks. Some of the information that is addressed on an assessment form may be beyond the expertise of the security officer or practice owner. Working with a technology support provider is a good practice for completing this assessment. The Dept. of HHS has an online SRA available at: https://bit.ly/3Pwg9NJ . 6. Failure to correct issues identified in the Security Risk Assessment A key mistake that many dental practices make is to complete the assessment form each year, but not address any of the risks that have been identified. In cases of HIPAA audits or investigations of complaints, the HIPAA auditors/investigators ask to see and thoroughly review the SRAs for a covered entity/practice. If any items identified as risks have been continually identified, but not addressed, citations and fines will be assessed. 7. Allowing access to patient-protected health information to unauthorized individuals This issue has many facets. It may include access to paper records or electronic records. In the case of paper records/charts and other documents with PHI, those documents must be kept secure, especially if there are cleaning professionals (who are not employees) who are present in the office after hours. The patient charts should be stored in lockable file cabinets or in a locked room, that only employees have access to. These service providers are not covered by BAAs, since their job doesn’t require them to access patient information. Cleaning staff and other service providers who may be at the office after hours when no employees are present should have a signed confidentiality agreement, in the case of patient information that may not be secure. Securing electronic PHI begins with using secure passwords for logging in to the practice management software. Each team member that has access to the software must have their own password. Technology experts say that passwords should be as long as the software allows (up to 20 characters), including upper and lower case letters, numbers, and special symbols, such as #, $,!. Passwords need to be changed regularly and most practice management software programs now have a default of 60 – 90 days for changing passwords. Team members should never use another team member’s password for logging in, nor should they disclose their password to anyone outside of the practice. A common practice is to write the password for a workstation on a sticky note and place it somewhere on the keyboard or monitor. This practice is not allowed. When team members leave their workstations for longer than a few minutes, or for lunch, they should either log out or lock the screen to prevent unauthorized access. Locking the screen is achieved by a number of keystrokes, and then repeating those keystrokes to unlock it upon returning to the workstation. Some software will allow the creation of a “hot key” that will execute this command. Check with your software provider to determine how to do this. Another way to lock the screen is to press the ctrl, alt, and del keys at the same time. This will either cause the screen to go blank or bring up the task manager. If the task manager comes up, select the lock, and the screen will go blank. Performing this same task on returning will again bring up the task manager and require logging back into the software. The user will be taken back to the patient record or task that they were working on when they locked the screen. 8. Sending electronic patient-protected health information by unsecured and/or unencrypted email There has been a great deal of resistance on the part of dental practices to adopt safe transmission practices with patient information. As many practices are utilizing digital radiography, emailing copies of these images is easy and convenient, when making referrals, or for transferring patients. But emailing this PHI through unsecure email channels is risky since the email can be intercepted during transmission. In most cases, the information that dental practices send is not highly sensitive, but if the message and attachment are not encrypted, it can allow hackers access to the practices’ server where the images are stored. Email hacking is also a security risk in that it can be infected with viruses and other malware. Dental practices should first use secure email. Secure email is achieved by utilizing the email services connected to the practice website, or by redirecting an existing Gmail or other account to a secure portal. Technology and web support services can assist with this. The benefit of using a secure email portal is that it greatly reduces the possibility of being hacked. Gmail, Yahoo, and other free email providers do not have the level of security needed for HIPAA compliance. Even if the practice is using secure email, any attachments with patient information must be encrypted, or transmitted through a virtual private network (VPN). Encryption typically requires a subscription to an app that copies the attachments, secures them in a vault, and makes them available to a recipient who logs in to the encryption service vault. Some of the encryption services can be integrated into the practice management software, requiring fewer steps to send the email and attachments. HIPAA rules exist for the protection of patient information and to protect a dental practice from liability if that information is accessed inappropriately. Protecting the privacy and security of patient’s information is not only a legal issue but an ethical issue as well. If a practice strives to provide the highest level of care, that includes protecting the patients’ information. Privacy and security issues are also good business practices, which all dental practices need to follow.

Published:
September 18, 2023
By:
Mary
Govoni
Face mask being held
Do Dental Teams Need to be Concerned About COVID Again?

The answer to this question is yes – but not to the level of concern during the pandemic.   The CDC, World Health Organization (WHO), and the news media are reporting increases in hospitalizations of patients with COVID-19, and two fast-spreading variants of the Omicron COVID variant. In addition, we are now entering into the very early stages of flu season, and the spread of Respiratory Syncytial Virus (RSV).   It is important to remember that dental practice facilities are at a higher level of risk for transmission of respiratory viruses because of the aerosols that are produced while providing treatment.    There is some discussion online and on news channels about the possibility of reinstating mask mandates.  Some hospitals have already instituted the mandates if the number of cases and hospitalizations are high in their area.  There is no mandate for dental practices to require patients to wear masks when they enter the facility, and this likely will not happen unless the cases increase very significantly. So, what do dental teams need to do at this time? First, dental teams should continue to screen patients prior to their appointments for the presence of respiratory symptoms.   If a patient is experiencing symptoms, the CDC recommends postponing treatment, unless there is an emergency.  Unless the patient has been tested (not likely), there is no way to know whether they have COVID, influenza, or RSV. There are tests available that screen for all three viruses, but they are not widely sought out by patients through healthcare providers. Current guidance from the CDC is accessible here:  https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html.  Keep in mind that while these are “recommendations”, many state dental boards require following CDC guidelines. These recommendations include using an N95 respirator or a higher level of protection for patients with confirmed or suspected COVID-19 (for emergency treatment). Second, teams should consider the types of masks or respirators that are used during treatment. Many dental team members have already ditched the respirators and gone back to using face masks for all patients. Masks with ASTM Level 3 ratings are the appropriate choice for aerosol generating procedures (AGPs).  But the limitation of these face masks is that they do not seal on the face like a respirator.   Many masks gap on the top and sides.   Teams should purchase masks that fit well and minimize the gaps.  Just to review – AGPs include the use of high-speed handpieces, air/water syringes, ultrasonic scalers, air polishers, and air abrasion.   In addition, the KN95 masks that were allowed under the Emergency Use Authorization (EUA) from the FDA during the pandemic are no longer allowed for use in health care settings, as they do not meet U.S. criteria for face masks or respirators and are not cleared by the FDA. Third, team members should stay home if they have respiratory symptoms.  Just as our patients may be infectious to us, we can be infectious to the patients and to co-workers.  A practice should have a clear policy defining what protocols should be followed if a team member has a respiratory infection as well as what to do about patients who indicate prior to their appointment that they have symptoms, or who present at the office with symptoms. And last but not least, consider getting a COVID-19 vaccine or booster if you have already been vaccinated.   The most updated vaccines are anticipated to be available by the end of September.   Check with your health care provider, local health department or pharmacy for information about vaccines and boosters.   It also is a good idea to get an influenza vaccine, which are currently available. Most of us are COVID-weary and don’t want to think about all of the craziness that happened during that time.   But COVID-19 is still a health threat, as are other respiratory infections.   As dental health care professionals, we need to protect our health as well as the health of our patients.   As with any vaccine recommendations, always check with your health care provider to make sure that they are appropriate for you and your current health status.    CDC Updates Respiratory Virus Updates https://www.cdc.gov/respiratory-viruses/whats-new/index.html

Published:
September 13, 2023
By:
Mary
Govoni
68b00e60-c82a-4748-b775-a96dcff3fd17
Dental Trends of Summer 2023

AI and technology have been in front of everyone this summer, but the real trend flying under the radar of many people in the industry is a growing resistance to selling your practice to the DSOs. The movement kicked into high gear after a DSO veteran, Dr. Brady Frank, posted an ad on Instagram urging dentists to sell their practice to DSO before the window for high multiples closed. Since then, many people have shared their opinions and horror stories of what happened when they thought selling their businesses would bring them freedom and wealth. The most critical questions on the issue were asked by the hosts of the Bulletproof Podcast, Dr. Craig Spodak and Dr. Peter Boulden: What is next after you sell? How are you going to deploy the capital? Do you have the confidence to put the money to work and generate a 10–15% consistent return? Most importantly, what are you going to do with the time? If you want to experience something close to that, take a month off, do what you always thought you would do when you retire, and see if you like it." These are fundamental questions that many dentists need more time to ask themselves before the sale. Many end up selling for the wrong reasons. Link to the podcast on Spotify Later, Dr. Boulden and Dr. Spodak started the movement #TeamNeverSell to encourage dentists to continue practicing independently and build their practices into resilient businesses that can provide financial and time freedoms without selling. My recent podcast with Brad Freeman (Spotify Link) discusses how rising interest rates will slow down DSOs' growth and provide private practices with a path to strengthen their position. There are still many questions facing both Private Practices and DSOs, and one of the most important is attracting and retaining associates. DSOs historically struggled to retain associates, but rising student debt made them more enticing for young doctors. However, all the things that make DSOs strong, such as standardization, simplifications, the narrow focus on offered procedures, and profitability, left the same DSOs vulnerable for young dentists to apply new skills and try new technologies. This is where private practices have become a beacon of private ownership in dentistry. Most private practices, at least once focused on excellence and growth, are constantly looking to add technology to their workflows (CEREC, 3D printing, lasers, digital scanners, etc.) and improve their clinical skills through high-level continuing education (Spear, Kois, etc.) and private coaching and masterminds. Yes, DSOs will give unlimited CEs, but the question remains: Can you apply what you learned at the practice where you associate? Other essential questions when it comes to evaluating the option to sell your practice to DSO or continue working as a private practice are: - Systematization of processes - Staffing (hiring, onboarding, training, and retaining) - Access to DSO-level pricing on supplies, labs, and equipment - Access to capital for associate doctors to buy into the practice - Positive Mindset and Burnout The good news is that there has been a boom in technical startups for most of the above questions. Take tech companies, such as ZenSupplies, Trainual, UptimeHealth, Lassie, and many more that are working hard to bring solutions to private practice at a lower cost than full-time employees usually do at the DSOs related to procurement, contract negotiations, systematization, insurance reimbursement, and equipment purchasing and maintenance. I expect complete integration of these solutions into your practice management software in the next 5-7 years to provide a seamless experience. When managing your mindset and positive outlook on the profession, there has never been a better time than now. It is now widely accepted that burnout and depression are a thing, and many doctors have shared their own experiences working through them while still practicing dentistry. With private coaching and access to mastermind groups, practice owners have a safe place to share their struggles with peers and help each other overcome the challenges. Industry leaders such as Dr. Mark Costes, Dr. Peter Boulden, Dr. Craig Spodak, Dr. Dave Maloley, and many more have all dedicated their entire masterminds and private coaching to helping private practice owners stay private and avoid burnout. The last unknown is the current market conditions and access to capital. With high-interest rates and student debt, it isn't easy to make big decisions for associate doctors to purchase or start a practice. For private practices to thrive, we need an easier way for associates to access capital to buy an existing practice from a retiring dentist. Ultimately, the doctor decides whether to sell or continue, but this is the best time to continue your solo enterprise, enjoy the freedoms it offers, and build wealth through hard work.

Published:
August 31, 2023
By:
Tiger
Safarov
IMG_5040
Increasing Case Acceptance with Better Dental Office Organization

Case acceptance is the key to a thriving dental practice. More importantly, it’s the first step to giving your patients the care they need to enjoy better health. You might get advice from a thousand different places about how to get your patients to sign onto their treatment plan so you can get to work. Unfortunately, the constant push to improve case acceptance rates can sometimes make us lose sight of the bigger picture: running the kind of practice that will help our patients trust us with their dental care. Let’s look at three simple principles that will help your office run as smoothly as possible while improving case acceptance. Build Trust by Being Well-Organized Case acceptance is a direct reflection on how capable you are at earning your patients’ trust. When you present a treatment plan, you’re asking your patient to trust that you’re recommending the right treatment and not taking advantage of them. It’s a lot to ask when many patients have a limited understanding of their treatment needs or the value of your care. Scrambling for materials, not having the instruments you need, or floundering during your case presentation because of disorganized diagnostics can all shake your patients’ trust in you. Ensuring punctual appointments is crucial, as making patients wait can lead to doubt when presenting treatment plans, especially higher-cost ones. Respect for their time fosters trust and confidence. Timeliness positively impacts the patient-provider relationship, increasing the likelihood of treatment plan acceptance. When appointments start promptly, patients are more receptive and engaged during the consultation, enhancing the overall experience. This patient-centered approach minimizes hesitation and encourages informed decision-making. Running a well-organized office (link: https://www.zensupplies.com/blog/systems-that-work-how-to-create-routines-your-dental-office-staff-will-dependably-follow/) helps patients feel confident in their choice to trust you with their care. Knowing where things are when you need them at all times helps to: -Improve your sense of authority. -Help patients see that you have everything under control. -Make you appear competent. Beyond looking like you’re on top of things, good organization makes the patient’s experience better. Good Organization Leads to Better Patient Experiences Many patients dread the idea of time in the dental chair. One sure way to improve your case acceptance rates is to make each procedure as fast and comfortable as possible without sacrificing the quality of your outcomes.  Every experience your patient has in your office sets their expectations for how things will probably go next time. If you can perform fillings faster than expected without any unexpected hiccups, your patient will remember how impressed they were with how organized your team was (more on how to trian dental assistants communicate more effectively) and how smoothly their procedure went. That means next time you recommend treatment, they won’t feel the usual dread and they’ll feel more confident scheduling and completing that treatment. Building a reputation for providing fast, stress-free care means patients won’t feel overwhelmed by the idea of getting the care they need. It also helps ensure they’ll tell their friends and loved ones about you! Decreasing Stress in Your Team Makes Your Office a Welcoming Place Beyond helping procedures go quickly and smoothly, running an organized practice (more on how to organize your dental practice ) will also help you create a positive environment for your staff and your patients. A well-organized, well-stocked dental practice tends to run more smoothly. The fewer speedbumps your staff has to deal with day to day, the less stressed they’ll probably be at work. That translates directly to a better experience for your patients.  Modernizing Your Office Makes It Easier to Stay Organized and Boosts Case Acceptance Dental offices with up-to-date technology have significant advantages when it comes to case acceptance. Let’s look at three areas where updating your office can have the biggest impact on case acceptance. 1. Digital Diagnostics for Convincing Case Presentations The vast majority of dental practices now use digital x-rays, which can add tremendous versatility and detail over traditional x-rays. However, if you stop at x-rays, you’re missing some of the most convincing and affordable pieces of technology in your diagnostic arsenal. Intraoral cameras should be a go-to at every appointment. It can be hard for patients to understand their treatment needs when they can’t see what we’re seeing. They say a picture is worth a thousand words, and a close-up, high-resolution image of cracks, caries, recession, and any other visible damage will do more for your case presentation than your words alone. Have a consistent, reliable method in place to organize your diagnostic images as they’re being added to your patient’s file. Many times, your dental software will have a system built in, but you may need to customize it to suit your flow and presentation style. The important thing is that you can show the patient what they need to see without searching for what you need. The more streamlined and organized your case presentation is, the more convincing it will be. 2. Update How You Communicate with Patients Good communication is key to building a great relationship with your patients. Modernizing how you communicate with your patients can significantly improve compliance when it comes to recall appointments and following up on needed treatments. There are tons of services for HIPAA compliant texting to remind patients of upcoming appointments and follow up with them about further treatment needs.  Building your digital footprint with effective social media strategies is another way to stay at the forefront of your patients’ minds so they’re more likely to follow up on recommended treatments. 3. Automate to Eliminate Paper Clutter and Mistakes Automating tasks is a great way to minimize excess paper in your office and avoid disruptions to how your practice runs. Even the most technologically advanced practices often still rely on pen and paper for everything from equipment maintenance checklists to ordering materials. Every extra piece of paper adds clutter, adds to mental burden for your staff, and makes mistakes more likely. While automation isn’t fool proof, it can drastically cut down on stress and decrease the potential for system breakdowns. Automation can cut down on stress and prevent problems that can shake your patients’ faith in your practice and your skills as a healthcare professional.  Software that can track your inventory, automatically replenish when needed, and coordinate between the various suppliers you work with can significantly improve the efficiency of your office (link: https://www.zensupplies.com/blog/5-reasons-why-dental-practices-need-an-inventory-management-and-procurement-software/), freeing you to focus fully on your patients, which is the best way to earn their trust. 4. Train your dental team to present a treatment plan. In an ideal scenario, the responsibility of presenting treatment plans doesn't solely rest with the doctors themselves; rather, it involves a collaborative effort from various team members, including dental assistants. It's not uncommon for instances to arise where the doctor briefly steps out of the room, prompting patients to turn to the dental assistant for insights. In this pivotal moment, the dental assistant's role becomes paramount, as they have the opportunity to provide a thoughtful and informed perspective. For instance, if a patient queries, "What do you think?" the dental assistant's response holds substantial weight. They might eloquently convey, "Mrs. Jones, your inquiry is valued. Our doctor possesses extensive expertise in this particular procedure, having successfully completed numerous instances of 'procedure X.' In fact, only last week, we performed the very same procedure with excellent results." This not only reassures the patient of the doctor's proficiency but also underscores the dental assistant's own insights, establishing a harmonious bridge of trust and knowledge between the patient and the dental team.

Published:
August 18, 2023
By:
Paige
Anderson
Communication - mindreading
Dental Assistants: How to Communicate More Effectively with Your Doctor/Employer

Many dental assistants that I interact with share with me that they have difficulty communicating with their doctor(s)/employer(s). As a result, they become unhappy with their jobs, less productive, and in some cases, leave the practice. Working in dentistry can be stressful under the best of circumstances. And when the circumstances are not optimal, effective communication between doctors and all team members is critically important. Experts in communication and performance agree that “better communication techniques help employees to better comprehend their roles, which in turn helps employees perform their assigned duties better. Resources and time can be saved through these techniques, therefore getting more work done and reducing stress” Assuming that the experts are correct, why don’t dental teams, particularly dental assistants and dentists practice better communication methods? Let’s explore how to enhance communication between dental assistants and doctors to increase productivity and decrease stress. Barriers to Communication: For dental assistants, there are several potential barriers to greater effectiveness in communicating with their dentist/employer. First is the dynamic of self-confidence. Currently, many dental assistants come to work in a practice with little or no experience. It can be difficult to approach a highly educated dentist with questions or concerns. Even experienced dental assistants have some challenges in approaching their doctors, who are not only the authority figure in the practice, but also the person who signs their paycheck. Over time, team members take on the attitude that they just need to accept how things are because they believe that their doctor(s) would not listen to their concerns or requests. Time works against effective communication in many dental practices. The pressure to stay on schedule while delivering quality patient care is stressful and can result in stressful reactions when running behind or treatment not going as planned. When under stress emotion takes precedence over logic when individuals interact with each other. Yet another barrier to communication that occurs frequently is a doctor/employer that has a non-confrontational behavioral style and avoids situations where issues may need to be discussed. This type of behavior is frustrating to the team members and may be perceived as a personal issue i.e., the doctor doesn’t like them or is unhappy with them. There are other barriers to effective communication, such as gender, race, cultural issues, socioeconomic differences, and family situations. The bottom line is that no matter what the barriers, dental assistants can be proactive in improving communication by following some specific steps to ensure successful and productive discussions with their doctor/employer. Step 1 – Evaluate the Situation Decide if the issue is urgent or if it can wait. An urgent issue would be one that would affect the patient currently being treated or a patient scheduled later that day. Another example would be an issue that arises with a team member who may not be able to perform their job, or who is acting in an offensive or appropriate matter. The latter also applies to patients behaving inappropriately. It these cases, it is in the best interest of the team to stop, take a breath and deal with the situation. This needs to be done in private, with the affected parties present, not in front of patients or the entire team. If the issue is not urgent, but the assistant believes it needs to be addressed, wait until a later time on that day to approach the doctor for a discussion. Attempting to talk to the doctor in between patients may not be the best time since their focus is on the patients, so finding a time during lunch break or at the end of the day may be more productive. Just because a dental assistant (or any team member) has an issue to discuss, it doesn’t necessarily mean that the doctor needs to be involved. Each team member should think about whether the issue is just a personal issue, or if it does affect patients and the team. If the latter is true, then the doctor needs to be involved in the discussion. If it is a personal issue, some introspection is in order before any resolution can be achieved. If, for example the dental assistant just doesn’t like or get along with another member of the team, s/he should approach that person first to find some common ground. Avoid putting the doctor in the middle! If the dental assistant wants to change how things are done, such as ordering supplies, then s/he must first decide if they just want their way or can the practice benefit from the change. In other words, we sometimes just need to get over our bad selves and realize that we don’t work in a perfect world, with everything the way we want it. Step 2 – Develop a Plan/Strategy After analyzing an issue, the dental assistant should develop a strategy for communicating with the doctor about it. This would include answering these questions about the anticipated discussion. What is the desired outcome from the meeting? Do you need an answer soon or will it wait? What type of information or documentation would help to support the dental assistant’s position? For example, if a dental assistant needs a new operatory stool, have ready a list the reasons (back pain, inability to adjust an old stool, etc.) and convey a benefit to the doctor, e.g., increased ability to see in the patient’s mouth during treatment. How would the doctor, patients, team, and the dental assistant from resolving the issue? Could a free trial of a new type of stool be arranged? Or is there a dental meeting that the team will be attending, where some research can be gathered? If a specific stool is desired, be prepared to share information on the stool, including the model and price. It is helpful to keep in mind that the doctor will want to know how they and/or the practice will benefit from any proposed change. The doctor may also question the validity of the issue – so be prepared. If the doctor says no to a specific request, a good reply is: “Is that no for now, or it is no forever?”. Practice saying this ahead of time. Step 3 – Select a Time and Place to Approach the Doctor Once prepared, be sensitive to the busyness in the practice on a given day, and other issues that may affect the doctor’s receptiveness to meet. Trying to grab the doctor’s attention as s/he is in the middle of the busy workday isn’t usually successful. A better time might be before the workday starts, during lunch, or at the end of the day. Make it easy for the doctor – keeping in mind that they may be fearful of a confrontation, or of being dragged into the drama that may be occurring among the team members. If the doctor states that it isn’t a suitable time to talk, ask when a suitable time might be. If the doctor won’t commit to a time, make another attempt the next day. If the doctor keeps putting off the conversation, that may be a sign that the doctor is avoiding the discussion. Step 4 - Get to the Point Once the doctor and assistant agree on a time to meet, don’t waste time on small talk, which individuals do sometimes when they are nervous. Get to the point – tell the doctor what the conversation is about, define the issue or problem, and present a solution (e.g., buy a new stool). Be open to listening to the doctor’s responses and answer questions when asked. Again, keep in mind that the doctor will want to know how an issue, change or purchase will benefit the practice and him/herself. Try to avoid becoming defensive of accusatory. Stick to the facts or data. As stated previously, if the answer is no to a request, ask if that is the final answer, or can the request be revisited in the future. Be sure to thank the doctor for meeting and listening to the concerns. Don’t walk away angry or with a bad attitude. That discourages the doctor from wanting to have future discussions or possibly reconsidering a request. Final Thoughts If a dental assistant is continually struggling to communicate with the doctor or other team members – ask them what to do to communicate better. Also ask what not to do to communicate better with them. Sometimes dental assistants are not a good fit on a particular team. If that is the case, seek out a team where the team culture is a better fit. Whining and gossip have no positive effects on team morale and shouldn’t be part of the culture of a dental practice. Remember that perception is different for everyone. We don’t all see situations the same. Remember that it is better to be kind than to be right in some situations. It is my hope that these thoughts give some insight into making conversations between dental assistants and doctors – and other team members a little more comfortable. Discussing concerns or issues is the first step to resolving them. Letting the issues go because of fear of bringing them up in a conversation doesn’t make the situation go away, in fact it may make it worse. Be positive and expect good outcomes. Allaya Cooks-Campbell, BetterUp, “Communication is Key in the Workplace. Here’s How to Improve. https://bit.ly/3O9UrgG .

Published:
August 2, 2023
By:
Mary
Govoni
IMG_5514
Stop Wasting Money on Expired Dental Materials!

Many dental practices don’t have a lot of wiggle room when it comes to their materials budget. Part of your overhead will always include some wasted supplies, but expired dental materials can add up to thousands of dollars down the drain (sometimes literally) every year. Let’s take a look at some of the most common dental materials that overstay their expiration dates and how you can minimize those losses. The Hidden Cost of Expired Materials There are certain materials that tend to pop up in every dentist’s mind when they think of the money wasted on lapsed expiration dates. What many of us consider is that, in addition to money wasted on unused purchases, some materials also require proper disposal which can carry its own hefty price tag. Amalgam needs a special receptacle and mercury suppressant as well as collection by a properly permitted management facility. X-ray developer and fixer can’t just be poured down the drain. Even unused local anesthetics should be marked as pharmaceutical waste and disposed of separately, not put in the normal sharps container. Although there can be a steep initial cost, modernizing your dental practice (link: https://www.zensupplies.com/blog/where-can-dental-offices-find-information-about-technology-innovations/) by going digital and moving away from more volatile materials will help prevent waste as well as decreasing overhead in the long run. The Most Common Offenders There are a few dental materials that have a track record for overstaying their expiration dates, even in state-of-the-art offices. Composite resins. Composite is one of the most common materials that expire in a dental office, especially unusual and rarely used shades. Anesthetic. Anesthetic carpules sometimes get shuffled to the backs of drawers or supply closets. Be sure to check your expiration date before every injection! Sterilization supplies. Enzymatic cleaners, ultrasonic solution, and even sanitizing wipes (link: https://www.zensupplies.com/blog/infection-prevention-and-control-in-the-news/) have expiration dates that sometimes go ignored. Patient products. Selling expired prescription toothpastes, mouthwashes, and other medicaments doesn’t shine a great light on your practice. Dental Material Black Holes: Where Materials Go to Expire Every dental practice has a few nooks and crannies where supplies and materials tend to disappear and go forgotten. Identifying these dental material black holes and coming up with good systems (link: https://www.zensupplies.com/blog/systems-that-work-how-to-create-routines-your-dental-office-staff-will-dependably-follow/) to keep stockpiles refreshed can significantly cut down on material waste. Supply Closet Disorganized supply closets lead directly to wasted materials, not to mention dust bunnies. Here are a few strategies to prevent expired materials in your storage area. If you’ve ever worked in a restaurant, you should know the “first in, first out” principle. Establish a strict policy for restocking when orders arrive of pulling the oldest materials to the front and putting the freshest at the bottom of the pile. That way, staff can easily grab the materials closest to expiring! Use clear storage containers. Containers are a great way to keep your supply closet organized and tidy. Clear containers ensure your staff can see what’s inside and prevent duplicating orders by mistakenly thinking you’re out of something. Bonus points if you have a label maker! Yearly or twice-yearly spring cleaning. Set aside time in the schedule once or twice every year for staff to roll up their sleeves and clear out supply closets and operatories. Pull everything out, wipe down and sanitize your storage areas, and then restock using FIFO and checking expiration dates for every item. As a hygienist, I’ll be honest: we hide supplies We’re like squirrels. Your assistants do it, too, I promise. Ideally, every operatory in your practice runs a full column most days. That means your hygienists and assistants don’t have a moment to waste prepping for their next patient or hunting for items. Secret stashes in operatories help us avoid slow-downs or running out of things we need, but they sometimes get stuffed in dark corners and go unused for months or even years. Setting aside time in the schedule for your staff to do a deep clean of their operatory and re-organize their supplies will help ensure cleanliness as well as prevent materials from expiring. Under Sinks and Other Low-Traffic Areas Sterilization and cleaning supplies are frequently stored under sinks and in other out-of-the-way places. Unfortunately, these areas are out of our eye line and can end up becoming expired material graveyards. Wherever possible, set aside storage space for these materials where they are easily visible and accessible, so they don’t end up relegated to dark corners of your office. Items that don’t expire like trash bags and paper supplies are better suited for those nooks and crannies. Good Ordering Routines Are Key to Eliminating Waste Finding the sweet spot for how much of each material to stock depends on many variables. Obviously, you don’t want to understock as running out of materials will disrupt your ability to treat patients. There are certain situations, such as the potential upcoming shipment disruptions (link: https://www.zensupplies.com/blog/alert-of-potential-order-delays-starting-august-1-2023-your-ups-orders-could-be-delayed-read-more/) when overstocking is a good idea. But in general over-stocking too much leads directly to expired materials. So how do you balance ordering to ensure you don’t run low on materials but they don’t go unused until they expire? First, make it easy for your staff to keep track of materials and when it’s time to re-order. Tag systems are incredibly helpful, and there are plenty of resources online for how to build an effective tag system. It can be high tech and use RFID, or simply a card with the relevant details written on it! Automating your ordering as much as possible is another great way to avoid supplies issues. Software that helps track inventory, automatically renew certain items on a set schedule, and easily adjust your orders will take out the guesswork and help you minimize waste without running low on what you need. Enjoy better flow in your workdays with well-organized dental materials and efficient ordering systems. Check out ZenSupplies to easily track your inventory levels, restock supplies in a timely manner, and reduce the chances of running out of essential items during procedures. ZenSupplies not only saves time but also minimizes disruptions during patient treatments, leading to smoother and more efficient workdays.

Published:
July 27, 2023
By:
Paige
Anderson
wynand-van-poortvliet-kWUZKKBR2Ag-unsplash
Alert of potential order delays, Starting August 1, 2023 your UPS Orders could be delayed. Read more…

We are happy to update our members on the possible UPS strike. According to the news, the union was able to reach an agreement and avoided the chance of UPS workers going on strike. More on this here. Dear Zen Members, We are monitoring the news regarding negotiations between UPS and the Teamsters union as they approach the end of their current labor agreement, which ends July 31, 2023. This is pretty serious if not resolved by the end of July and may result in order delays. Our team is preparing in case that happens to provide timely and accurate information about your orders and help with the delays. What can you do in the meantime: - Purchase items that you use the most in the next 2 weeks. This could be: - Gloves, Masks, Wipes - Pouches - Lidocaine and Injectables -Plan to purchase exactly the brand you like and regularly order to avoid potential returns and order shortage frustrations. -If you purchase from 2-3 suppliers, plan to order from more vendors. Suppliers such as DentalCity often times use FedEx that will not be affected by this strike. We are also gathering information provided by top distributors and wanted to share what they had to say about this: Patterson Dental In the unfortunate situation where a strike occurs: - UPS will still be operational in a very limited capacity with priority given to healthcare companies such as Patterson. - Patterson will utilize all carriers that are available, including FedEx, regional carriers, courier services, and Patterson delivery. - Expect delays in processing orders and shipping as other freight carriers will also have delays as a result of the UPS strike, and rural areas should expect greater delays. To help minimize the impact if a strike occurs: - Be mindful of the key items your practice needs to ensure you have appropriate inventory levels for the week of August 1, and please refrain from over-purchasing inventory. - Consolidate your orders to one order per week during the strike to help with the processing and timeliness of shipping. - Please understand that additional measures may be taken including suspending returns during the strike to help lessen shipment volume. Henry Schein Henry Schein has a contingency plan in place to have orders shipped on time. Some orders may not be delivered the next day as normal. Safco Dental We know how important it is for you to get your supplies on time. Unfortunately, a potential UPS strike is creating uncertainty. Should a strike occur, we cannot guarantee the same quick delivery times as overall logistics in the U.S. will be affected. We recommend stocking up on essential supplies by the end of July to mitigate risk of not having what you need for your practice. In the event of a strike, we will not be able to guarantee delivery dates, but rest assured we’ll do everything in our power to ensure your order is ready and shipped to you as soon as possible. We will continue keeping you informed of this issue. Please feel free to reach out with and questions. Your ZenTeam

Published:
July 18, 2023
By:
Tiger
Safarov
Light blue Minimal Dental Clinic
Systems That Work: 
How to Create Routines Your Dental Office Staff Will Dependably Follow

Effective systems keep your dental office running smoothly. The better business is, the more efficient your systems need to be. A thriving dental office means a consistently full schedule. Over time, systems may start to break down as steps get skipped and tasks fall to the wayside. Building systems that work for your team means your office can keep running as smoothly as possible so you can focus on giving your patients the best possible care. Areas of the Office First, let’s break down the goal of successful systems in each area of a typical dental office. Front Desk/Concierge Your concierge is a patient’s first point of contact when they enter your practice. Disorganization, paper clutter, even dusty computer screens can give your patients the impression that your entire practice is likewise disorganized and even dirty. Regular routines for dusting, sterilizing high-touch areas, and minimizing clutter will keep your front desk looking spotless. Sterilization Poor organization in sterilization puts your patients and entire staff in danger. Improperly sterilized instruments can spread serious bloodborne illnesses. Failure to comply with strict regulations also puts your practice in danger of running afoul of regulatory entities like OSHA. Establish effective routines for keeping your sterilization equipment in good working order, handling instruments safely, and staying on top of tasks like changing out the ultrasonic bath. Operatories Regardless of whether you choose to assign specific operatories to each clinician or prefer to have them rotate based on the day’s schedule, effective systems for organization in each operatory allow your team to work together to keep each room properly stocked and sterilized. Supply Closet/Inventory A well-organized inventory helps prevent over- or understocking supplies, which can directly impact the profitability of your practice. When carpules of anesthetic get shuffled to the back of a dusty closet and left to expire, it’s money down the drain. Ordering Aside from how you organize your physical supplies, effective systems for ordering likewise keep your practice running smoothly. Ordering for a dental office means coordinating the needs of each department in your practice as well as multiple suppliers and reps. Efficient systems for ordering supplies and instruments will prevent over- and under-stocking, and ensure deliveries arrive when they’re needed. What Makes a Good System? Next, let’s look at a few universal concepts that will help you build effective organizational systems for your dental office. These ideas can apply to every area of your office to help them run more smoothly. Simplicity is the key to systems that work. Every extra step is one more thing that will eventually get skipped and lead the system to break down. Streamline your systems as much as possible; what is the fewest number of steps that will reliably get this job done, and what is the most direct way to achieve each of these steps? Simplicity in your systems also means minimizing the mental burden of keeping track of tasks. The more you can automate reminders for things like spore tests, the less likelihood they’ll get forgotten. Most of us are painfully aware that time is a limited commodity in a thriving dental practice. Your assistants, hygienists, and treatment coordinators need systems that will save them time. Need labels properly filled out for biohazard bags? Why not print out sheets of stickers in advance so your staff can grab and stick in seconds rather than filling them out by hand? Simple adjustments to save a few moments on each step in your system add up to an office that runs efficiently and less chance of important tasks falling to the wayside on busy days. When you combine simplicity and speed, you get convenience. Convenient systems are more likely to be followed. It seems obvious. But when you look closely at the workflow in your office, look for any areas where the system could be easier to maintain. For example, cassettes make instruments easier (and safer) to carry. We all have pedometers on our smart watches, but your staff doesn’t have the time or energy to make their 10,000 steps on unnecessary movement between patients! Once you’ve established systems that are simple, fast, and convenient, make sure the expectations are consistent and predictable. Any new system may take some trial and error as unforeseen problems come up. But constantly changing your systems in the pursuit of better efficiency can be frustrating and confusing for everyone involved. Get your staff’s input from the beginning about what works for them and what needs improvement. Then, give new systems some time to become habits and check back with them for feedback about how things can be tweaked or improved. Maintain Your System for Peak Efficiency Once you find a rhythm and routine that works for your team, maintain it! Keeping a system in good working order over time takes planning, but you can work it into the system from the beginning. Make a plan to periodically check in on your system. While constant changes can lead to disorganization, re-evaluating your system regularly (maybe once per quarter for example) needed can allow you to adapt and eliminate roadblocks. For truly peak efficiency, look for any areas where you can establish systems that maintain themselves. Automating workflow and organization as much as possible frees your staff to focus on providing the best possible experience for your patients while eliminating human error or forgetfulness. Automation in your systems can be as simple as setting a cell phone alert for weekly or monthly equipment maintenance. Specialized software can help you easily track your previous orders, automatically place regular orders, and coordinate lists between multiple suppliers so your staff doesn’t have to waste time do it by hand. Above all, remember that the goal for systems that work is to help your entire team enjoy better flow in your workdays and allow you to give your patients undivided attention at every visit!

Published:
July 12, 2023
By:
Paige
Anderson
Respiratory Infection Risk
Infection Prevention and Control in the News

Now that COVID-19 isn’t dominating the infection control news stories (although it is still present), we turn our attention to some additional news regarding infectious disease transmissions that may affect us in dentistry.  Some of the information is good news and of course, some is not so good.   Recently the Food and Drug Administration (FDA) granted approval for two new vaccines for Respiratory Syncytial Virus (RSV).,  The vaccines are the first for preventing this serious respiratory virus.  According to Gavi The Vaccine Alliance, RSV infects millions of people globally each year with lower respiratory tract infections, with mild symptoms.  Young children and older adults are particularly vulnerable, and many are hospitalized for treatment of the infections.  RSV infections can also be fatal, especially in patients with underlying medical conditions. These new vaccines, approved for individuals over 60, is reported to reduce the risk of severe RSV-related lower respiratory disease by 94%.  RSV is characterized by the Centers for Disease Control and Prevention (CDC) as an infection of the lower respiratory tract that includes symptoms of runny nose, decreased appetite, coughing, sneezing, wheezing and fever.   These symptoms are similar to COVID-19 and influenza however, a single nasal swab test (PCR) can detect which of these viruses is occurring in a patient.   Some danger signs in children and adults that indicate the need for immediate medical intervention include difficulty breathing, stridor (wheezing, grunting or high-pitched sounds with each breath), coughing or wheezing that does not stop, decreased alertness, bluish skin, tongue or lips, dehydration, and high fever (104°F).  According to the CDC, in the 2022-2023, the overall rate of RSV-associated hospitalizations was 51.9% per 100,000 people.  The CDC’s National Respiratory and Enteric Virus Surveillance System (NREVSS) is an excellent resource for dental health care providers to monitor RSV, influenza and other respiratory virus trends in the area where their dental practices or clinics are located.   This information is updated weekly by states and regions in the U.S. If the pandemic taught us anything in dentistry, it is that the threat of respiratory infections can be serious, and that dental health care personnel are at risk of exposure from patients and from each other.   Even though the pandemic is over, endemic COVID-19, influenza and RSV infections continue to spread.  Reappointing patients who have respiratory symptoms should be a standard protocol in every dental practice, with the exception of patients needing emergency treatment. The CDC recently reported that cases of malaria were identified in Sarasota County, FL and Cameron County, TX.  These four cases, not related, are believed to be locally acquired, which is not as common as cases that are acquired when individuals travel to countries where malaria is common.   Malaria is a parasitic infection, transmitted through mosquito bites.  If not treated, malaria can be fatal.  The CDC, along with state and local health departments are increasing efforts to raise awareness among professionals and the public of the potential risk of malaria and other mosquito-borne infections.   Preventive measures include DEET-containing insect repellent, loose-fitting long-sleeved shirts and pants and utilizing screens on doors and windows.  Symptoms of malaria infection include: fever, shaking chills, headache, muscle aches and fatigue.  Nausea, vomiting and diarrhea can also occur, along with anemia and jaundice.  If not treated promptly, malaria infection can cause kidney failure, seizures, mental confusion, coma, and death.    Candida Auris According to the CDC and the Association for Professionals in Infection Control and Epidemiology (APIC), Candida Auris (C. auris) is an emerging fungus, discovered in Japan in 2009.  It is considered to be an urgent antimicrobial resistance threat.   The CDC states that it is spreading at an alarming rate in hospitals and long-term care facilities.  Of great concern to health care professionals is that C. auris is difficult to identify, often is mistaken as a bacterial infection, and medical laboratories must have specific technology to correctly identify it, which is beyond standard laboratory methods.  The most concerning issue is that C. Auris is resistant to the most commonly used antifungal medications.   It is easily spread in health care facilities and is especially harmful to individuals who have weakened immune systems.  In these individuals the infection may enter the bloodstream, causing what is described as an invasive infection. Although no cases of C. auris infections have been associated with oral health care, it is possible that an infectious patient may be treated in a dental practice.  Patients may be ill from other types of medical conditions, and they may be experiencing fever and chills as the result of a C. auris infection.   This reinforces the need to monitor every patient’s vital signs, including temperatures, at the beginning of each visit.   During the pandemic, the CDC recommended checking temperatures before patients were admitted to the dental office.   While that is no longer necessary, taking a patient’s temperature and blood pressure is considered a good medical practice.  And the temperature and blood pressure needs to be recorded in the clinical note.   Unless it is an emergency, or the fever is believed to be caused by a dental infection, these patients should be reappointed until they are well enough for oral health care procedures. In addition, if appropriate disinfecting protocols are not followed with all patients, C. auris could be spread to other patients and dental health care professionals.   In most cases the tuberculocidal disinfectants that are used in dentistry will be effective against C. auris, but dental professionals can look up their disinfectants on the Environmental Protection Agency (EPA) list for emerging pathogens to determine if the product they use is effective against C. auris. Dental Unit Water Quality Bacterial infections resulting from patient treatment using untreated, contaminated dental unit water continue to be investigated by the CDC.   While most of the cases identified have affected pediatric patients who received pulpotomies, adult patients have been infected as well.   The CDC states that any dental unit with untreated water is a potential infectious disease threat to patients.   It is also a threat to dental health care providers as well, due to the exposure to aerosols created from that water. Much attention has been directed at how to treat the water, and there are many products on the market that are effective in controlling microbial contamination, but the issue still exists.   There are several reasons why this is the case, including a lack of consistency in using the waterline cleaner/disinfectants, not following the manufacturer’s instructions for use of the product, lack of shock/cleaning of the dental unit waterlines according to the equipment manufacturer's instructions and product instructions, and a lack of testing to determine if the products or procedures followed are actually working. Every dental practice needs to have a waterline protocol in place that includes training for the team to understand the risks of using contaminated water, selecting the appropriate product that is compatible with the dental units in the practice, a testing protocol, and a protocol to follow if a dental unit fails to meet the CDC recommended <500CFU/ml.   The CDC has a great deal of information on its website about dental unit water quality that can help guide a dental practice to establish and follow the necessary protocols. Taking a Broader View of Infection Prevention and Control As dental professionals, we sometimes view issues in a narrow context – only looking at what directly affects the delivery of oral health care.   It is important to recognize, however, that comprehensive oral health care includes recognizing what is occurring in the global context of infectious disease.  In many cases dental professionals dismiss some issues as irrelevant because very few or no infections have been documented in dentistry or are unlikely to occur in dentistry.   Dentistry is a profession of preventing oral disease and should also be a profession of preventing the spread of infectious diseases. U.S. Food and Drug Administration: https://www.fda.gov/vaccines-blood-biologics/abrysvo U.S. Food and Drug Administration: https://www.fda.gov/vaccines-blood-biologics/arexvy  Gavi.org  https://www.gavi.org/vaccineswork/rsv-vaccines-are-we-close-taming-one-worlds-biggest-killers-children  DC RSV-NET: https://www.cdc.gov/rsv/research/rsv-net/dashboard.html#:~:text=In%20the%202022%2D2023%20season,was%2051.0%20per%20100%2C000%20people. CDC NREVSS: https://www.cdc.gov/surveillance/nrevss/rsv/state.html  CDC: https://www.cdc.gov/malaria/new_info/2023/malaria_florida.html CDC FAQ’s About Malaria: https://www.cdc.gov/malaria/about/faqs.html  CDC Increasing Threat of Spread of Antimicrobial-resistant Fungus in Healthcare Facilities: https://www.cdc.gov/media/releases/2023/p0320-cauris.html  CDC Invasive Candidiasis: https://www.cdc.gov/fungal/diseases/candidiasis/invasive/index.html  EPA List P: Antimicrobial Products Registered with EPA for Claims Against Candida Auris: https://www.epa.gov/pesticide-registration/list-p-antimicrobial-products-registered-epa-claims-against-candida-auris   CDC Dental Unit Water Quality: https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/dental-unit-water-quality.html

Published:
July 5, 2023
By:
Mary
Govoni
What are the challenges when choosing an endo file system|Wave one gold|unnamed (2)|unnamed (1)|Pro Taper Gold|peeso reamers|unnamed|Gates Glidden (1)|unnamed|C+ Files|My project-1|Screenshot 2023-06-30 at 19.53.10
What are the challenges when choosing an endo file system?

Written by Dr Aaron Nicholas, DDS www.MondayMorningDentistry.com As the saying goes “It’s a pretty sorry carpenter that blames his tools for a failed result”. But the opposite is also true. If we have a great result, it’s not because of the “tools” that were used. Sure, great tools make getting that great result easier, but great tools in the hands of an unskilled operator will not turn him or her into a savant. So, since we’re going to be talking about endodontics, let’s stop talking about tools and start talking about instruments. If you read and believe too much of the marketing in the dental literature, you might start to entertain the idea that all you need to be a great endodontist is the latest great file or irrigation system. Or you might talk to a colleague who has discovered THE file system that will solve all of the challenges they have been having with instrumentation. “No, really. Its amazing. I haven’t separated an instrument this year.” Or maybe you were trained on a particular system and are hesitant to switch because it’s what you know and you’re afraid of having even more issues with an unknown. Not an unreasonable fear. Just as we don’t want to blame our instruments for our “failures”, we also don’t want to give them too much credit for our “successes”. I became a doctor in the 80’s before NiTi and rotary instrumentation even existed. Back then the success rates were comparable to the success rates that we are seeing today with endodontic therapy. So, it’s not the instrumentation. What the current generations of instruments has done for us, is make it easier and less fatiguing to perform endodontic therapy. They have made obtaining the desired shaping much more technology driven as opposed to being operator driven. Less “art” more “system” thus allowing doctors with much less experience to create better and more consistent outcomes. All wonderful achievements. But they aren’t magic. Let’s start at the top What Challenges Are We Trying To Overcome? Almost universally, when I talk to doctors during our 1 Hour Molar RCT, Buildup and Crown course (shameless plug) the three issues that have finally convinced them to refer out all their endodontic cases come down to three things: 1.I can’t find all the canals consistently and in a timely manner. 2.When I’m instrumenting everything Is going fine till the last few millimeters and then I get blocked out or ledge.  After that, I can’t get through the blockage or past the ledge, so I must refer the case out anyway.   Or it takes so long that it wrecks my schedule.  3.I’ve separated enough instruments and had that conversation with enough patients enough times that I don’t ever want to go through that again. So, it’s easier to just send it out and I’ll do the crown when the case comes back. I think we can agree that challenge number one is not one that we expect that a better file system is going to cure. There is some technology and training that can make this easier and more streamlined but we’re not trying to cover that here. Challenges numbers two and three are commonly blamed on or have cures attempted by the selection of our file system.  In truth, both challenges are merely symptoms that a greater problem that has already occurred “upstream”. The blockage or file separation is merely the symptom of this. It’s not the real issue.  To consistently not have these issues requires a greater degree of knowledge, training, and practice.  However, the file system selected with these challenges can give the operator a bit more “grace” and latitude to solve the upstream issues before they become catastrophic. Technology Drives Acceptable Processes Before nickel titanium, there was still root canal therapy.  Canals still had to be instrumented.  Debris still had to be removed. And healing still had to take place. It was just done a little differently.  Typically, the coronal end of the canal was opened with a series of Peeso Reamers or Gates Glidden instruments.  It could also be done with a combination of K and H files, but usually some assortment of rotary instruments were used to speed up the process.  In using these, the dentin triangles were removed, and this set the operator up to negotiate the canal system to the apex. I remember sitting in lecture and the endodontist talking about the “beautiful wine bottle shapes” that could be seen on the radiograph after successful instrumentation and obturation. This shape was created by orifice opening with Peezo reamers and then hand instrumentation. If we saw an obturation with that shape today, we would all be critical of the undue amount of dentin that had been removed.  So truly our technology drives what we deem to be acceptable treatment. So, let’s talk about what you came here for, the files. Hand files There are two major considerations in choosing hand files.  Size (diameter) and stiffness (flexibility). Most of us were given a size 10 (purple) file as our smallest file when we were in our initial years of training.  While that might be sufficient for anterior teeth or less calcified canals it is not sufficient for the challenges that prompt most GPs to start referring their endodontic cases. In our office, we keep and regularly use both #6 (pink) and #8 (gray) files.  If it’s a highly calcified case, I don’t even attempt the #10, I go straight to the #6.  Using too large of a file in a canal too soon is one of the surest ways to create ledging.  While it might take a couple more minutes to run through the #6 and #8 before introducing the #10, it will take FAR longer to diagnose and correct a ledge or blockage created by an incorrect file sequencing. As far as file stiffness goes, C hand files were a game changer for me.  A C file is the same diameter as its counterpart but it’s a stiffer file. Additionally, the #6 C file is end cutting.   In my practice we use C files to cut through blockages that have been created by dentinal “sludge” being packed apically during instrumentation.  Just like the smaller K files we keep these in sizes 6,8, and 10.  When needed, it is not unusual to go through a box of #6 C files to restore patency. Those tiny blades (flutes) get dull quickly. A small price to pay to keep the procedure in house and moving forward to completion. The Four Horsemen As file systems have progressed there have been numerous improvements that are mixed and matched to achieve better results.  None can be completely separated from the others.  At present there seem to be four major variables. 1.Structural design - The first popular rotary systems were introduced in 1992.   Changes in structural design have been ongoing since day one.  Structural design refers to all the tapers, variable tapers, flute designs and file cross sections.   2.Manufacturing treatment – Soon thereafter (1999) companies started looking for ways to manufacture stronger more consistent quality files.  Variables here would be twisting wire, milling, electropolishing, etc. 3.Metallurgical developments – Still looking improve strength and flexibility (2007), file manufacturers started incorporating heating and cooling the metals to achieve stronger files with increased flexibility and resistance to fatigue. Enter the gold and blue files to which we have become accustomed. 4.Movements – Improvements to the motions that the files make came next and are still ongoing.  This includes things like off-center rotation of the file as well as reciprocating and pure rotary filing.  Also included are motors that measure torque on the file and unwind to reduce forces before a separation might occur. Hand Piece-Driven File Systems Hand files do a great job, but they take a longer and make fingers sore and tired.  Enter handpiece driven filling. This basically breaks down into three types of systems.  Sonic and ultrasonic, rotary or reciprocating systems. Sonic or Ultrasonic I remember trying various sonic and ultrasonic filing systems years ago.  It seemed like the files always separated at the tip or became embedded in the canal wall.  Both situations would necessitate stopping the procedure, correcting the problem, and then starting again.   Frequently, only to be challenged by the same issue all over again.  As I was doing research for this article, I couldn’t find a single sonic/ultrasonic system that recommended using the instruments for enlarging the canal.  Most were recommending using it for agitating the irrigants used during the procedure. So, we’re left with reciprocating and rotary filling. Reciprocating Filing Systems Reciprocation systems are ones in which the file isn’t just going round and round. Sometimes the motion is 180 degrees clockwise and 180 degrees counter-clockwise. Other systems, cut 150 degrees counterclockwise and then 30 degrees clockwise to disengage the file. There are many other systems out there with many different reciprocation patterns.  Most claim a proprietary pattern to make their files work effectively. Intuitively, reciprocating filing seems a little safer since the file isn’t moving in an unending circle. This probably played heavily into the decision most dental schools made to provide one of these systems for their students to learn on.   The other might be that a lot of these systems are “one file” systems. So cost is presumably less, and the process is less complicated.  Some systems even claim that a reciprocating motion reduces apical transportation of the canal terminus compared to full rotary files.  This, however, is controversial and at least one study has created doubt in regard to the claim.  Using a reciprocating file compared to a rotating file can take longer to instrument the canal (the file is not cutting all the time it’s in the canal space) and it is more likely to push debris into the periapical tissues.  But these, for the most part, seem to be minor issues.  It is still far superior to hand filing an entire case and yields more consistent results in less experienced hands. Which is not to say it’s a “beginner’s file system”.   It just has a much easier learning curve. Final outcomes are stellar. Rotary Filing Systems Now we come to “true” rotary files.  Files that rotate in one direction, pretty much continuously.  Rotary files have numerous strategies for achieving final canal shape. Some are more “crown down” while others finish different areas of the canal in sequence. Some have a variable taper in the same file while other use a consistent taper within the file but a different taper between files. Almost universally though, manufacturers recommend hand filing to a #10 or #15 before introducing rotary files into a canal system.  This usually does not include using the rotary orifice opener that comes with many systems. Rotary systems will tend to push less debris apically and typically allow the operator to finish instrumentation more quickly than with a reciprocating system, even if multiple files are being used in the purely rotary system. To add to our confusion, different handpiece manufacturers claim superiority based on sensing of torque on the file and having automatic settings to stop rotation or to stop and temporarily reverse the motion until stress is relieved. If the motor is paired with an apex locator, most such systems will allow the operator to set a distance from the apex where they would like to stop filing.  Sensing this measurement, the handpiece will auto reverse the file at the pre-appointed measurement. And finally, we come to metallurgy of the files, both rotary and reciprocating. Originally,  NiTi files were not heat treated and not very flexible by today’s standards.   Almost all rotatory files at present are heat treated.  Not to go into a lot of manufacturing science but there are basically two types of heat treatments currently.  Both achieve a tougher file that is less likely to break under load. Looking at a file that appears gold in color is the original commercially popular heat treatment. It created a file that was tougher, more flexible and had some memory.   This treatment dramatically reduced the number of file separations that doctors experienced. It gave them a bit more grace and latitude in over torquing a file and possible separation.  While a lot of doctors were working well with the original NiTi files, this extra breathing room greatly reduced the number of separations of files and the stress on the doctors performing treatment. A slightly different heat treatment leaves the file with a bluish or purplish hue.  Files with this treatment tend to be even more flexible and with a bit less memory.  All while not giving up the toughness that helped reduce the incidence of separations. In the hand, both feel comparable.  More experienced operators might be able to feel that the bluish/purplish heat-treated files are a little “softer”, but it doesn’t seem to affect cutting efficiency or reduce strength.   Additionally, a more flexible file in a more tortuous canal seems like it would be a big advantage. If you are looking for a definitive answer to “What is the best file” or “Which system should I buy” I don’t think it’s a straight-forward evaluation and decision. A lot depends on your previous experience and what challenges you are encountering.  I encourage you to ask around, look at the claims and research regarding different systems and see what seems to make sense.  Insist that the rep allow a reasonable demo period so that you can try it out on some extracted teeth. (Acrylic blocks don’t give any insight on how the file will perform under clinical conditions).  Use what seems right and feels good when you are actually performing the procedure. Don’t be impressed by “proprietary” anything.  We all think our stuff is best. As they say “The proof is in the pudding” And remember, it’s not the files doc.   You’re the magic in your treatment.

Published:
June 30, 2023
By:
Tiger
Safarov