Reprocessing Gaps

In September 2015, the Organization for Safety, Asepsis and Prevention (OSAP) – the organization dedicated to dental infection control and patient safety – introduced the Safest Dental Visit™, an initiative designed to promote an increased commitment to infection control and safety. Clinicians, educators, speakers and consultants, product manufacturers and distributors, and others are collaborating to help ensure that every patient visit is the safest one. In this month’s First Impressions, we feature high points of the CDC’s newly released summary of infection prevention practices. The CDC guidelines are the foundation of the Safest Dental Visit.


Reprocessing Gaps

Attentive participants at 2016 Annual Conference.

Attentive participants at 2016 Annual Conference.

As dental personnel reprocess items for reuse, compliance with relevant regulatory agencies is required. However, dental personnel may face “gaps” in regulations, instructions, and feasibility of reprocessing certain instruments and devices. Examples include the cleaning of items that are difficult to clean, and safe methods of removing dental materials from sharp instruments.

Two experts facilitated a discussion of such gaps – and how dental practices can bridge them – at this summer’s 2016 Annual Conference of the Organization for Safety, Asepsis and Prevention (OSAP), “Leading the Way to the Safest Dental Visit™.” They were Karen Daw, MBA, CECM, an authorized OSHA trainer and Clinic Health and Safety Director for The Ohio State University College of Dentistry; and Nina Mazurat, MSc, DDS, of the College of Dentistry, University of Manitoba.

First Impressions gathered comments from both following the OSAP conference.

“I first recognized there are problems with medical device reprocessing when I attended the Canadian Association of Medical Device Reprocessing in Winnipeg, October 2014,” said Mazurat. “At that time I recognized that although we are processing our instruments correctly and our patients are safe, we are not receiving enough information about medical device reprocessing and therefore we are not as sophisticated about this topic as we should be.”

Added Daw, “Gaps in instrument processing appeared on the radar because dental personnel have expressed difficulty with compliance with relevant regulatory agencies in this area.” Many device issues defy easy resolution, she said, including the reuse of some single-use devices, such as burs; infection control questions relative to multi-use dispensers; and disinfection of high-technology devices, such as digital impression wands and radiography sensors.

“What was interesting about this presentation [at the OSAP conference] is that participants included dental team members (assistants, hygienists and dentists), educators, consultants, manufacturers, healthcare administrators and military personnel, to name a few,” she said. “And they all had wonderful questions and comments. Apparently, ‘gaps’ are not unique to any one person, and the discussion was a unifying topic among these various stakeholders.”

Training

Shown at the auction at OSAP 2016 (left to right): Marguerite Walsh (Henry Schein, treasurer OSAP board), Peggy Cottrell (one of the founders of OSAP), and Mike Smurr (Patterson Dental and new chairman of OSAP).

Shown at the auction at OSAP 2016 (left to right):
Marguerite Walsh (Henry Schein, treasurer OSAP board), Peggy Cottrell (one of the founders of OSAP), and Mike Smurr (Patterson Dental and new chairman of OSAP).

Changing and improving the dental practice’s approach to instrument processing starts at the beginning – the purchasing of dental instruments.

“When it comes to infection prevention and control, generally dentists step away and allow their staff to take over,” noted Mazurat. But when it comes to sterilization, they are keenly interested, which might explain the large number of dentists in attendance at the “Gaps” discussion.

“Partly this is because dentists are making the choices for purchasing items, and we are finding that we need a culture change when purchasing devices,” she continued. “The days of purchasing devices and then, almost as an afterthought, assuming that their processing can be achieved with a normal cycle, are over. Due to technology and increased sophistication of our devices, many are being sold from parts of the globe where the processing cycle is different than our tabletop sterilizers will allow. We are conflicted with either ignoring those instructions or not using the device. Dentists are becoming keenly aware of this concern.”

Better training is needed, said Mazurat.

“I don’t think that there has been any change in training for years,” she said. “There needs to be increased training, so that people who are processing know that manufacturer’s instructions have to be consulted for every device in the dental office.” Areas in which training is needed include:

  • Quality assurance, whether using biological indicators or using process-challenging devices (PCDs).
  • The impact of conditions in the processing area, such as humidity, temperature and negative pressure.
  • Quality assurance in cleaning instruments and devices prior to reprocessing.
  • Specific areas of concern, including sterilization of air/water syringe housing, suction housing and handpiece adaptor sterilization.”

Step it up

Dr. John O’Keefe (left), chairman of the OSAP association board from 2014 to 2016, is congratulated by Dr. Don Marianos, chairman of the OSAP Foundation board, at the 2016 Annual Conference.

Dr. John O’Keefe (left), chairman of the OSAP association board from 2014 to 2016, is congratulated by Dr. Don Marianos, chairman of the OSAP Foundation board, at the
2016 Annual Conference.

Oftentimes, dental assistants have responsibility for instrument processing, pointed out Daw. “[But] in some states, they are not required to take any type of formal training before being placed in charge of this very important responsibility. In essence, they were not being set up for success in this critical role. Dentists and hygienists also may have received minimal instruction in instrument processing, yet the doctors are the ones that end up on the 6 o’clock news when there is a breach in infection control in the practice.”

At The Ohio State University, all dental and dental hygiene students rotate through Central Sterilization, where they receive live and online instruction in instrument processing and relevant guidelines, Daw explained. The central sterilization department is staffed with dental assistants who have been certified through the International Association of Healthcare Central Service Materiel Management, or IAHCSMM.

“I remember attending Eve Cuny’s (University of the Pacific) fantastic OSAP presentation on this years ago, demonstrating there is a place for instrument processing education in schools,” Daw continued. “I think it is a matter of ‘You don’t know what you don’t know.’

“It would be great if instrument processing could be included in educational curriculum at all schools, and if the training could include discussion of FDA regulations, manufacturers [instructions for use] and best practices, for starters. Continuing education in this area would be beneficial as well. I feel, overall, the dental community is receptive and doing a fantastic job, and that organizations like OSAP assist by framing the narrative and facilitating ongoing discussion.”

Said Mazurat, “We have to become better educated. We need help from medicine, and we need to start using more certified sterilization technicians in our areas. Hopefully, this was just the beginning of a whole new area of learning in OSAP.”

Momentum’s Building

Mike Bileca

Mike Bileca

By Mike Bileca, president, ADSO

The Association of Dental Support Organizations is excited for all that’s ahead in the second half of 2016, building on the momentum of a terrific year so far.

In April, at the 2016 Annual Summit, the Board approved eight new DSO members, and since January, we’ve welcomed 27 new Industry Partners. Our membership is increasing as the industry grows, and ADSO now has over 50 DSO members and nearly 150 Industry Partner members. We are also expanding our membership to include other oral-healthcare-related associations.

I want to take a moment to thank everyone who attended the 2016 Annual Summit. We had the best turnout yet, with over 750 attendees. The Summit was a true indication of how much our industry is growing.

Attendees heard from leading DSO CEOs, industry and business experts, colleagues, industry partners and vendors, and many others during the packed two-day event. There were opportunities for networking, learning from others in the DSO industry, and gaining political insights from the keynote speaker, nationally recognized political commentator Charlie Cook. If you haven’t already seen it, check out the Summit highlights video.

We look forward to seeing everyone next year March 7-10 in Orlando, Fla.

As many 2016 legislative sessions have adjourned for the year, our Government Affairs team did a tremendous job of advocating on behalf of our industry. Our team did exceptional work in preventing anti-competitive legislation, championing model legislation, and advocating for dental board appointments. Our record of success continues, as there are now more than a dozen DSO-supported dentists on various state dental boards.

Finally, I’d like to thank Steve Thorne, president and CEO of Pacific Dental Services, for his service as president of ADSO this past year. His leadership and vision for the industry resulted in ADSO’s most successful year to date with increased membership, enhanced compliance guidelines, and a proactive government affairs education effort on the DSO role in helping dentists improve quality, affordable oral healthcare. Steve will continue to serve on the Executive Committee and I will continue to rely on his leadership.

I am honored to have been elected by the Board of Directors to serve as your president and look forward to being at the forefront of ADSO’s continued growth.

The Silent Epidemic

Dental practices need effective infection control protocols to guard against Hepatitis C

EGP-NovDec.15-iStock_000058700480_FullThe chances of group practices encountering patients with the hepatitis C virus (HCV) – sometimes referred to as the “silent epidemic” – is high. In fact, public health experts estimate that about 1.6 percent of the U.S. population is either currently infected or has been infected with HCV in the past. Most don’t even know it. All this is reason why practices must strictly adhere to infection control protocols at all times.

That was the message from a group of experts from the Centers for Disease Control and Prevention during a recent webinar on hepatitis C sponsored by CDC, the Academy of General Dentistry, and the Organization for Safety, Asepsis and Prevention (OSAP). The webinar was part of OSAP’s Safest Dental Visit™ campaign.

What is hepatitis C?
Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks, to a serious, lifelong illness that attacks the liver. There is no vaccine for HCV.

Symptoms are often non-existent – or at least not recognized – in adults with acute HCV (that is, short-term illness usually occurring within six months of infection), and are rarely present during chronic disease until liver inflammation is severe, said Anne Moorman, BSN, MPH, Division of Viral Hepatitis, CDC.

While the incidence of HCV has declined over the past 25 years, currently, at least 2.7 million people in the United States are estimated to be HCV-infected. Seventy-five percent are estimated to be baby boomers (born between 1945 and 1965). Of infected persons, only about half are estimated to have had their infection diagnosed, and of these, only up to one-third have been referred for care. Data from 2012 showed that at that time, only 11 percent had been treated, and only 6 percent cured.

Since testing to screen blood and blood products for HCV became available in 1992, new hepatitis C infection rates have declined dramatically. Even so, an estimated 30,000 new acute cases were contracted in the United States in 2013, with new cases among all age groups, but the greatest increase among young, non-urban adults injecting drugs.

Because the adverse effects of liver disease take decades to develop, the number of people with manifestations of acute hepatitis illness – and resulting hospitalization – is still rising. The rate of HCV-related hospitalizations in the United States more than doubled between 2004-5, and 2010-11. The number of deaths from HCV increased between 1999 and 2007. But even that may be under-reported. In one study, only about one-third of people known to be infected with HCV who died from end stage liver disease had HCV reported on their death certificates.

How is it spread?
The primary mode of HCV transmission is blood to blood, e.g., through an injection or break in the skin. In the environment, HCV in plasma can persist in an infectious state for 16 hours or longer, and in water at low temperatures for up to five months. In vitro studies have shown that HCV may remain infective on dry surfaces for up to six weeks. Disinfectants that inactivate hepatitis B virus will also kill HCV virus on environmental surfaces, and commercial hand antiseptics are effective in inactivating the virus on hands.

Bloodborne pathogen transmission in healthcare settings can occur from patient to patient (e.g., because of improper infection control practice), from patient to provider (e.g., as a result of needle sticks), or from provider to patient (e.g., during surgery or because of provider drug diversion). Note that approximately 60 percent of dentists are baby boomers, and so may have undetected past or current infections themselves.

Reports of transmission of hepatitis B (HBV) or C in the dental setting are rare. That said, many cases are no doubt missed by routine surveillance, given the long incubation period of HCV. In fact, only three reports of patient-to-patient transmission of HBV or HCV in the dental setting have been reported.

  • In 2002, a case of patient-to-patient transmission of HBV was reported. Investigators believe that an elderly woman, who had no traditional risk factors, contracted the virus following oral surgery. It turns out that a patient with a high viral load had had a procedure earlier in the day. Presumably, a lapse in cleanup procedures following the earlier case was the cause.
  • In 2009, transmissions of HBV were reported among patients and volunteers attending a portable dental clinic (a gymnasium setting). Investigators identified several infection-control breaches, including failure to heat-sterilize handpieces following use, failure to package instruments prior to sterilization, failure to adequately train volunteers on infection control protocols, and more.
  • The only documented case of HCV patient-to-patient transmission in a dental setting occurred in a dental surgery practice in Oklahoma in 2013. Unsafe injection practices, improper dating and storage of multidose vials of controlled drugs, and a lack of autoclave monitoring and maintenance were all cited as potential causes.

Post-exposure management
About one person in 30 (ranging from 0 to 7 percent from various studies) whose blood has come into contact with that of an HCV-infected person is likely to contract HCV, said Jennifer Cleveland, DDS, MPH, a dental officer and epidemiologist in the Division of Oral Health within CDC. (Contrast that with HBV infection, where the risk is between 6 percent and 30 percent, or as many as one person in three; and HIV, where the risk is about 0.3 percent, or one person in 300.)

The elements of an effective post-exposure management program include:

  • Clear policies and procedures
  • Education of dental healthcare personnel
  • Rapid access to clinical care, post-exposure prophylaxis, and testing of source patients

If the practice determines that a patient or dental healthcare worker may have been exposed to HCV, the practice should:

  • Discard or sterilize the instrument or needle.
  • Provide “first aid” to the exposure site, such as wound management or eyewash for blood exposures. The wound should be washed with soap and water, but not with bleach or caustic agents. Neither should the caregiver squeeze or milk the wound, or apply a tourniquet.
  • Fill out an exposure report, including date and time of exposure, details of the procedure (where, how, with what device), exposure details (route, body substance involved, etc), and information about the source patient.
  • Refer worker to a qualified healthcare personnel.
  • Request source patient testing.
  • For the exposed person, perform baseline and followup testing for HIV, HBV surface antigen, anti-HCV and liver enzyme activity.

For more information about HCV, visit the “CDC Viral Hepatitis – Hepatitis C Information” website at http://www.cdc.gov/hepatitis/HCV/index.htm.

Editor’s note: Introduced in September 2015, OSAP’s Safest Dental Visit program is an initiative designed to promote an increased commitment to infection control and safety. Clinicians, educators, speakers and consultants, product manufacturers and distributors, and others interested in patient safety are collaborating to help ensure that every patient visit is the safest dental visit. For more information, go to www.osap.org. First Impressions readers can view the hepatitis C webinar at www.agd.org/olc.

Thinking Differently

The value in recognizing and managing through complexities

By Randy Chittum, Ph.D.

Roger Martin refers to this capacity as having an opposable mind. In other words, do we possess the ability to hold oppos- ing thoughts? Doing this requires an unwillingness to settle for an “either/or” when a “both/and” is still possible. And yet, as humans, we are drawn to the certainty we feel when we choose. Holding out on prematurely solving a dilemma requires a comfort with ambiguity that many of us lack. Of course we cannot settle in this ambiguity forever. At some point we will have to make the call and get into action. In my experience with leaders, what animates this process is the recognition that certainty is not the same as truth, or right. Certainty is in principle an emotion. Uncertainty is a primary fear. We will often make poor decisions in the service of certainty. Marilyn Ferguson wrote; “we are more certain that ever, but less informed and far less thoughtful.” I believe that sums it up very well. My simpler advice to leaders is to “beware certainty.” Certainty is likely a false promise. What it actually delivers is comfort. You may also notice how often in meetings the victory goes to the person who seems most certain about his or her position. Again, beware certainty!

What would it look like instead if we “sat with the questions” rather than immediately try to answer them? How would things be different if we took time to explore underlying assumptions? What would be the advantages of not leaping to a conclusion? What if, instead of seeing complex issues as problems to be solved, we saw them for what they probably are – polarities to be managed? Polarities are interdependent “opposites.” In truth, polarities are a huge part of organizational life. We just don’t recognize them for what they are. This is in large part because we prefer the certainty of a problem solved.

Examples of common polarities include flexible and clear, relationship and task, and emergent and structured. In all three cases an argument can be constructed for both “sides.” It is when we see the polarity as choice that we create risk. For example, you cannot really choose between relationship and task. An over-focus on relationship to the exclusion of task brings with it both upside and downside.

The poet Rainer Maria Rilke wrote “be patient toward all that is unsolved in your heart and try to love the questions themselves.” A differentiating characteristic of great executive leadership is the capacity for seeing what others cannot. This is not exactly magic, though it may look that way to those who can’t see. It turns out that “seeing” differently is predicated on “thinking” differently. A key characteristic of thinking differently is the ability to hold opposing thoughts and not feel an overwhelming need to choose one or the other. This article is about that ability.

Nov/Dec 2015 EGP

EGP-NovDec.15Click Here to Read the current issue
(w link to PDF download)

From The Publisher

Thinking Differently
The value in recognizing and managing through complexities

Do You Have a Grand Challenge?

“We Already Do That”
Maximizing the potential of your hygiene team by spotting opportunities

Taking Care of Business
DSO membership allows dental specialists to do what they do best.

A Team Effort
When DSOs, their specialists and distributor sales reps work together, patients receive better care solutions

Built to Last
Value is the bedrock of successful DSOs

Satisfaction. Guaranteed?
More than ever, DSOs are paying attention to what patients think and say about their care.

The millennial dentist: Great expectations

VOCO America, Inc.

Measuring the Day-to-Day
Survey of dental office managers shows pain points, opportunities

OneMind Health

The Silent Epidemic
Dental practices need effective infection control protocols to guard against Hepatitis C

Best Practices in Infection Control

Healthy Habits: Ho, ho ho…
Oh, no, no!

Needed: More DSO-supported dentists on state dental boards

News

 

news

Aspen Dental to help more veterans access dental care
Aspen Dental- (Syracuse, NY) branded practices launched “A Smile for Your Service,” a limited-time 25 percent discount offer on dentures and general dentistry for those serving in the military, veterans, and their spouses, designed to help expand access to dental care. Additionally, each time the offer is shared via Facebook (SmileForService.com/Share), Twitter, or Instagram, using the hashtag #HealthyMouthMovement, Aspen Dental will donate $1 to Got Your 6, a veterans’ organization that helps strengthen communities and empower veterans nationwide. This new program is part of Aspen Dental’s larger commitment to veterans, which has included more than $2 million in donated dental care to nearly 4,000 veterans in 2015 through a volunteer effort called the Healthy Mouth Movement.


Heartland Dental opens new offices in FL, SC, and IN
Heartland Dental (Effingham, IL) announced a new affiliation with existing dental offices in: Lehigh Acres, Florida; Sarasota, Florida; Camden, South Carolina; and Plantation, Florida. The company also announced newly opened offices in: Davenport, Florida and Greencastle, Indiana. Heartland Dental provides support services, including education, staffing, procurement, marketing, and IT services, to more than 1,000 dentists who operate out of 675 dental offices in 31 states


ADAA foundation changes name to Dental Assistants Foundation (DAF)
The American Dental Assistants Association (ADAA) (Bloomingdale, IL) changed its name to the Dental Assistants Foundation (DAF). The announcement from foundation chair Ellen Landis, director of operations, training, and development for Affordable Care Inc (Raleigh, NC), clarifies the intention to re-focus and re-brand its support to all constituents of DAF. Dental assistants with expanded functions, as well as clinical and administrative assistants, will benefit from the fundraising efforts of the organization. The DAF will continue its commitment which began in 1993 as a 501(c)3 not-for-profit to enhance the standards and skills within the dental assisting profession. Beginning in 2016, new initiatives will include a robust social media campaign with a new website (DAFoundation.net), and research to determine the needs of the foundation’s members, both professional and personal.


ACTEON North America announces the release of the PSPIX phosphor plate scanner; initiative to add clinical trainers to assist sales force
ACTEON North America has announced the release of its next generation phosphor plate scanner, the PSPIX. The PSPIX features a very small footprint, high quality and contrasted images, incredibly fast acquisition times and removable parts for easy sterilization. Tightly integrated with Sopro Imaging software, the PSPIX is available for both the Windows and OS X operating systems and can be shared across a local area network. “The PSPIX provides exclusive advantages to our practitioners,” said Tim Long, VP and COO of ACTEON. “The reduced footprint is 3 times smaller than any other plate scanner and the PSPIX can be placed chair side providing a marked increase in productivity and improved patient experience…” continued Long. “By providing offices with a small and affordable scanner that has ‘Click and Scan’ functionality, practices can now be dedicated to patient care and comfort” said Long.
ACTEON North America has also announced an initiative to add clinical trainers to assist their existing sales force. Clinical trainers are dental professionals who will provide product training, product in-service, continuing education, and clinical expertise in the dental offices, conferences, and trade shows. These clinical trainers will be available at no additional cost to any new, existing, or potential ACTEON customer. “ACTEON products help provide superior clinical results, and we will be offering value added services that assure each existing or potential customer receives proper training and education from one of their peers.” said Tim Long, VP and COO of ACTEON. “For example, our clinical trainers can help educate an office that is transitioning from analog film to one of our digital radiography solutions like the PSPIX imaging plate scanner.”

ACTEON clinical trainers are available for immediate scheduling through your ACTEON Manufacturer Representative. For contact information visit http://www.acteonusa.com/find-a-rep


Ivoclar Vivadent announces executive team promotions
Ivoclar Vivadent’s (Amherst, NY) CEO, Robert Ganley, announced the promotions of several members of the company’s North American executive team. Sarah Anders, who joined the company in 2003, was promoted to the newly established position of chief operating officer. George Tysowsky DDS, who joined the company in 1985, was promoted to SVP technology and professional relations. Michael Gaglio, who has been with
Ivoclar Vivadent since 1999, will become SVP marketing and digital communications. And Pierre Lamoure, with the company since 1985, will be SVP clinical sales.


Midmark announces corporate leadership changes, expands Emerge Stronger® Advanced Education Series for dental customers
Midmark Corporation (Dayton, OH) appointed Anne Eiting Klamar MD as its chair of the board (COB) of directors. Klamar has served as the company’s president since 2000 and added the role of chief executive officer in 2003, making her the fourth generation of the Eiting family to hold a leadership position. John Q Baumann was appointed to the position of president and chief executive officer. Baumann is currently serving as chair of the board of directors for Midmark. As COB, Klamar, along with other board members, will work with Baumann to set the overall direction for the company’s continued growth and long-term health. She also will provide leadership for the company’s governance structure as well as the company’s regional and industry commitments. Klamar and Baumann will assume their new roles by January 4, 2016

Midmark Corporation also announced the expansion of its advanced education series, Emerge Stronger®, to meet the increased demands of dentists who wish to design an office that will take their business to the next level. To accommodate dentists from various locations, Midmark has increased the number of Emerge Stronger seminars at its Versailles, Ohio location, and in cities throughout the U.S. To address the growing trend of dentists who want to deliver an inviting and captivating overall patient experience, the Emerge Stronger Educational Series program was designed to help them understand what it takes to enhance their office space for optimal economic benefits and an improved patient experience. Starting in 2011, Emerge Stronger two-day seminars were crafted to assist dental professionals in the renovating, expanding or building of a new dental practice. The seminar focuses on design, zoning, construction and several other key topics led by notable speakers, Pat and Dr. Jeff Carter of Practice Design Group. The Carters, a licensed interior designer and registered dentist duo, formed Practice Design Group in response to dentists seeking a more collaborative and innovative design resource than was available through the dental supply houses and other formula-driven dental office design companies. For more information regarding the Emerge Stronger Educational Series, please visit midmark.com/emergestronger or call 1-800-MIDMARK, ext. 8923.

UMKC awarded HHS grant to examine oral health disparities among children in KS
University of Missouri-Kansas City (UMKC) (Kansas City, MO) School of Nursing and Health Studies and School of Dentistry were awarded up to a $4.38 million National Institutes of Health (NIH) (Bethesda, MD) grant to study disparities in oral health among Kansas schoolchildren. UMKC said in a news release that the funds will be used to examine the oral health of pre-kindergarten- through high school-aged children in mainly rural communities who get school-based care from dental hygienists. UMKC investigators will collaborate with the Kansas Bureau of Oral Health School Sealant Program (Topeka, KS). Since 2003, Kansas has allowed dental hygienists who meet certain criteria and have a sponsoring dentist to deliver care directly to children.


News of the Weird: Astronauts use toothbrush to fix stubborn bolt during spacewalk
In 2012, when a problem cut the amount of electrical power available to the International Space Station, spacewalking astronauts triumphed over a stubborn bolt and installed a critical power switching box with the use of a blue toothbrush. Thanks to out-of-the-box thinking, electrical systems were restored. Engineers on the ground and the astronauts in orbit scrambled to devise makeshift tools to clean metal shavings from the socket of the troublesome bolt

Needed: More DSO-supported dentists on state dental boards

By Lauren Rowley

EGP-NovDec.15-iStock_000011725431_LargeThe ADSO Government Affairs Committee was formed this summer. The committee, chaired by John Pantazis, Heartland’s vice president, general counsel and secretary, with representatives from six other ADSO member companies, meets monthly and is charged with providing the ADSO with strategic guidance on state and federal legislative and regulatory issues. Among the committee’s top priorities is promoting DSO-supported dentists for appointments to state dental boards.

Board appointments are a top priority for the ADSO government affairs team because many of the state issues the DSO industry faces grow out of dental board actions. We believe that having one or more DSO-supported dentists or strong public sector members on the board involved in discussions and rule-making will go a long way in mitigating state legislative and regulatory issues, like those the industry has faced in recent years.

With few exceptions, dental board appointments are made by the governor of the state. Dental boards generally consist of dentists, hygienists, public sector (non-dental-related) members and sometimes academics. All states have rules around the appointments and can include: how long the term of service lasts; requirements on how long the candidate has been a resident of the state; how long the dentist/hygienist has practiced in the state; what area of the state the appointee needs to be from; as well as many other possible requirements. Since the appointments are made by the governor of the state, often political preference will also apply to the candidate’s selection process. ADSO assists our members in understanding these requirements when requesting candidates for appointment.

While ADSO is happy to promote candidates in any state, we recognize that we are much more likely to have success in those states where we have a contract lobbyist on the ground to assist in shepherding the candidate(s) through the process. The lobbyists are able to meet with the governors’ appointment staff and follow up throughout the decision-making process. They can also assist the dentist in getting letters of support from state legislators or other recognized leaders in the state to support their nominations.

ADSO requests that our members make a committed effort when openings come up to reach out to their supported dentists for potential candidates. To make sure our members are informed, we include in our Government Affairs Weekly Round-up – distributed every Friday to our DSO members – the list of states with lobbyists where we need our members help to promote candidates. (For membership information, e-mail membership@theadso.org).

In the past year, the ADSO has helped get DSO-supported dentists on the dental boards in Colorado, Iowa, Indiana and Florida, and is actively working on appointments in every other state where we have lobbyists.

Lauren Rawley is senior vice president of government affairs and COO, Association of Dental Support Organizations, a non-profit organization representing dental support organizations to the public, policymakers and the media. For more information, go to http://theadso.org

Healthy Reps: Ho, ho ho…

<strong>Oh, no, no!</strong>

<a href=”http://www.repertoiremag.com/wp-content/uploads/2015/12/REP-Dec.15-iStock_000035833790_Large.jpg”><img class=”alignright size-full wp-image-3116″ src=”http://www.repertoiremag.com/wp-content/uploads/2015/12/REP-Dec.15-iStock_000035833790_Large.jpg” alt=”REP-Dec.15-iStock_000035833790_Large” width=”200″ height=”168″ /></a>If the holidays fill you with a sense of dread, you are not alone. From gift shopping and wrapping to office parties and family get-togethers, for many, it’s a season of stress. Particularly for those coming off the heels of a personal tragedy or battling clinical depression, December is not the cheery month it’s made out to be.

Learn to recognize your holiday triggers, such as financial pressures or personal demands, advises the Mayo Clinic, and “combat them before they lead to a meltdown.” With a little planning and some positive thinking, almost anyone can find peace and joy during the holidays. Mayo Clinic recommends taking the following steps:
<ul>
<li><strong>Don’t ignore negative or sad feelings. Acknowledge them.</strong> If someone close to you has recently died or you can’t be with loved ones, realize that it’s normal to feel sadness and grief. You can’t force yourself to be happy just because it’s the holiday season.</li>
<li><strong>Reach out.</strong> If you feel lonely or isolated, seek out community, religious or other social events. They can offer support and companionship. Volunteering your time to help others also is a good way to lift your spirits and broaden your friendships.</li>
<li><strong>Be realistic.</strong> The holidays don’t have to be perfect or a repeat of past holidays. As families change and grow, traditions and rituals often change as well. Choose a few to hold on to, and be open to creating new ones.</li>
<li><strong>Set aside differences.</strong> Try to accept family members and friends as they are, even if they don’t live up to all of your expectations. Set aside grievances until a more appropriate time for discussion. And be understanding if others get upset or distressed when something goes awry. Chances are they’re feeling the effects of holiday stress and depression, too.</li>
<li><strong>Stick to a budget.</strong> Before you shop for gifts and food, decide how much money you can afford to spend. Then stick to your budget. Don’t try to buy happiness with an avalanche of gifts. (Some alternatives to gift shopping include donating to a charity in someone’s name, making homemade gifts, or starting a family gift exchange.)</li>
<li><strong>Plan ahead.</strong> Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus, and then make your shopping list. And, when hosting parties, ask for – and accept – help with preparations and cleanup.</li>
<li><strong>Learn to say no.</strong> Saying <em>yes</em> when you should say <em>no</em> can leave you feeling resentful and overwhelmed. Friends and colleagues will understand if you can’t participate in every project or activity.</li>
<li><strong>Don’t abandon healthy habits.</strong> Don’t let the holidays become a free-for-all. Overindulgence only adds to stress and guilt. Some healthy suggestions include:
<ul>
<li>Eat a healthy snack before holiday parties to avoid going overboard on sweets, cheese or drinks.</li>
<li>Get plenty of sleep.</li>
<li>Incorporate regular physical activity into each day.</li>
</ul>
</li>
<li><strong>Take a breather.</strong> Make time for yourself. Even 15 minutes alone, without distractions, can refresh you enough to handle everything you need to do. For example:
<ul>
<li>Take a nighttime walk and stargaze.</li>
<li>Listen to soothing music.</li>
<li>Get a massage.</li>
<li>Read a book.</li>
</ul>
</li>
<li><strong>If necessary, seek professional help.</strong> If in spite of all efforts, you find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores, talk to your doctor or a mental health professional.</li>
</ul>
For more information visit <a href=”http://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20047544?pg=1″>http://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20047544?pg=1</a>.

Best Practices in Infection Control

By Dr. John Molinari and Peri Nelson


Q: I poked myself with a sterilized Cavitron tip yesterday and got a very deep cut on my hand. What is the proper procedure for working with patients when I have this type of injury? I am a hygienist and constantly wash my hands and don gloves all day. Is there a risk of staph infection?

EGP-NovDec.15-iStock_000015257109_LargeA: The fact that the accident occurred with a sterilized tip suggests that the risk of subsequent infection from the tip itself is very low, depending on the efficacy of the sterilization cycle. As for what to do after the accident, your practice should already have a post-exposure management plan in place as component of the larger infection control plan. This may be labeled as “Exposure Incident Protocol” or something to that effect in the compliance manual.

Washing hands very well immediately after the accident is important, and I assume that was what was done. After that, follow up that same day with the medical facility your practice is contracted with for post-exposure evaluations would be able to determine what type of treatment and/or temporary barrier was needed for the finger (i.e. stitches, antibiotics). The medical professional who saw you may also give their opinion about whether you should practice immediately depending on the extent of the wound.

As for practicing, the routine hand hygiene procedures (i.e. hand washing and alcohol-based hand sanitizers) used as a component of your standard precautions work well. Remember also you are wearing gloves for every patient and these serve as a good barrier to protect skin.

Improving the Patient Experience

Sponsored: Awestruck Dental


The JawDropper Multi-Functioning Dental Device from Awestruck Dental

“Open wider, please!” Dentists and dental hygienists probably say that to their patients dozens of times a day. Every practitioner, and every patient, knows that holding the mouth open throughout a 45-minute appointment is uncomfortable, stressful, and for many, difficult to maintain even with a few short breaks. It can be especially painful for patients with temporomandibular disorders. The jaw muscles are some of the strongest in the body and they naturally want to bring the teeth and lower jaw back into occlusion. Numerous bite-block, mouthprop, and isolation devices have been developed to aid in keeping the mouth open, but they do not address the predilection of the jaw joint and muscles to resist being open for long periods, the associated muscle and joint fatigue, or the anxiety a patient may be struggling with just to keep the mouth open.

The JawDropper was invented by, Dr. Dick Fulton, a retired interventional radiologist and prolific inventor with numerous medical device creations. Dr. Fulton was experiencing difficulty keeping his own mouth open wide enough during a procedure at his dentist’s office.

As his jaw became fatigued, which resulted in reduced opening over the course of an appointment, it occurred to him to hook his index finger over his mandibular teeth and pull his lower jaw down. He found that he experienced greater comfort while helping to create a wider mouth opening.

This led Dr. Fulton to develop a tooth-engaging, plastic, wand-type of device that is shaped with a hook at one end to secure the lower teeth and a loop on the other end for the patient to grasp with an index finger or thumb. The patient can rest that arm on his or her chest and support it gently with the other arm during treatment. The original JawDropper attaches to slow speed suction, which enables the patient to control fluid evacuation as needed. The new 1.5 version, which can be preordered now, features an additional fluid evacuation attachment made of soft, pliable plastic that extends to the molar area, making it ideal for use during ultrasonic cleaning.

The benefits of patient control
The JawDropper offers an added benefit – the patient is in control of the device and more engaged in the procedure. This has been found in several studies and beta testing to reduce some of the pain and anxiety patients experience during their appointments. Participating in their comfort level gives them a sense of control that they are otherwise lacking in the dental chair. It feels less invasive and results in fewer breaks to relax the jaw. It also provides the dentist and hygienist with the “third hand” they really need and enables them to focus more on their tasks with better access and efficiency.

In terms of patient acceptance, using the disposable, multifunctional JawDropper during hygiene and appropriate dental procedures shows patients that the dental practice is taking forward measures to improve the practice and their customers’ experiences. It stands to reason that when patients are comfortable and have a more relaxed, positive experience, they are more likely to be receptive to future recommended treatments. Introducing patients to the JawDrop per during hygiene visits may increase case acceptance as well as patient retention.