How to Leverage Emotions at Work

By Lisa Earle McLeod

When was the last time you felt inspired? What made you feel that way?

If you’re like most humans, inspiration requires an intense level of emotion.

Research tells us if we want people to act, we have to appeal to their emotions. Neuroscientist Paul Zak researched the physiological impact of emotional stories. He measured the blood of participants before and after he told them an emotional story vs. a flat narrative. Both stories were aimed to get the participants to donate money. The “flat” narrative did not increase oxytocin or cortisol, and participants did not report empathy for the story’s characters. Those who were subject to the emotive story were willing to give 56 percent more money to the cause, which the researchers later revealed as made up. Dr. Zak concluded emotionally engaging narratives inspire post-narrative action.

So what can we learn from Dr. Zak’s experiments? If you want people to act, you can’t just make them think, you have to make them feel.

Fear-based leaders know this, that’s why they why create cultures of fear.  Fear is a feeling that will prompt action. But only short-term action, and only enough action to remove the fear. It’s not sustainable.

As a leader, formal or informal, you want people to be inspired. You want to ignite positive emotions, you want people to buy into your ideas and work hard for the organization or cause.

The more you can help people see an emotional picture in their mind, the more emotionally engaged they will be. Paint mental pictures of customers you help, the impact of projects you’ve done, or in some cases, the consequences of not doing whatever you need to do. Include names, details, how the other people feel, and the lasting impact you had on them. Telling one emotional story about a specific customer, how they looked and how they felt, is more powerful than saying we helped 10,000 customers this week. An emotional story will sustain people on their worst days because it allows them to connect the dots from what they are doing to who it is impacting.

Let’s say you work in distribution for a plumbing company.

Which sounds more appealing to you, “Our customers are depending on us to get these orders out on time.”

Or “I remember hearing about the Jones family, in Washington. They had six-week-old twins when their basement flooded. The wife, Karen, was really nervous about mold and moisture in their house. They were living in her mom’s basement waiting for their house to be repaired. With both babies and all their stuff in cramped quarters, it put a lot of stress on their family. Because we got the parts there on time, they were back in their home in two weeks, and were confident the home was safe for their children. There are thousands of families like the Joneses who are depending on us to get these materials out on time.”

Which cause are you more interested in, getting parts out on time, or getting the Jones family back into their home?

As a leader, you don’t need to lie, or over exaggerate. You simply need to authentically bring emotion to the front and center of your organization.

We’ve been told not to get emotional at work. Neuroscience has now proven, that’s the worst advice ever.  Emotions drive inspiration.  When you help others feel inspired, it has a ripple effect right back to you.


Lisa Earle McLeod is a leading authority on sales leadership and the author of four provocative books including the bestseller, Selling with Noble Purpose. Companies like Apple, Kimberly-Clark and Pfizer hire her to help them create passionate, purpose-driven sales organization. Her NSP is to help leaders drive revenue and do work that makes them proud.

November/December 2017

 

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More Than a Logo
Branding and the DSO

From The Publisher
Helping DSOs Flourish

ADSO Partnering for Growth 2017 conference

How to Leverage Emotions at Work

Lasers in Hygiene
Have you considered?

Solutions that Work
Training across a large DSO calls for sensitivity on the part of the manufacturer

Tools for Success
Excellent training and thorough education lay the groundwork for optimal patient outcomes.

Raising the Bar
As dental practices – both large and small – face greater demands, service technician Greg Rehms works harder than ever to exceed expectations.

The Ideal Cure
As curing technology has become increasingly sophisticated, curing lights have become more and more diverse, leading dentists to question which light solution and bulk fill composite best meets the needs of their practice.

Instructions for Use
What they are and why they are important to the dental practice

OSAP: Hit the Ground Running
The OSAP Dental Infection Control Bootcamp™ 2018 experience offers attendees an opportunity to enhance their infection control knowledge.

KaVo™ ELECTROmatic™ System

The Ethical Choice
A great handpiece design makes it easy for dentists to follow sterilization protocols.

Taking control
TF™ Adaptive by Kerr Endodontics removes the uncertainty from root canal treatment,
allowing dentists to focus on an ideal patient experience and exceptional results.

Industry News

Taking control

Sponsored: Kerr Endodontics

TF™ Adaptive by Kerr Endodontics removes the uncertainty from root canal treatment, allowing dentists to focus on an ideal patient experience and exceptional results.

At Chicagoland Smile Group – a growing network of 12 multi-specialty dental practices and 45 dentists and dental specialists – delivering quality clinical patient care and a positive patient experience is a daily priority. To ensure his dental teams meet their high standards of care, founder and president Dr. Roshan Parikh encourages them to use high-quality, reliable tools, such as Kerr Endodontics’ TF™ Adaptive system, designed to give clinicians greater predictability, control and efficiency when performing root canal treatment. “Patient care can be challenging, so we don’t want lesser-quality materials and instrumentation to prevent us from providing our patients with an optimal experience and results,” he says. “For that reason, we rely strictly on materials and instrumentation that are predictable, time and time again.”

Gaining experience, building confidence
“We offer endodontic therapy at all of our locations,” says Dr. Parikh, adding that both his endodontists and general practitioners perform root canal treatment. Indeed, not all clinicians leave dental school with the confidence to do so, he admits. “In dental school, students typically are considered competent after completing as few as five root canals,” he says. In fact, some programs – even those that include postgraduate endodontics – teach students to refer root canal treatment to an endodontist, particularly if it’s not a straight-forward procedure, he adds. “And lack of experience results in a lack of confidence.”

The easy-to-use TF™ Adaptive system puts clinicians in control, enabling them to focus on a better patient experience and superior results, notes Dr. Parikh. A patient’s tooth anatomy may not be predictable, but the TF™ adaptive system is, he points out. “The TF™ Adaptive’s reciprocating files can cut through – and reach – the apex with an efficiency that translates into decreased chair time for the patient and increased production time for the dentist or dental specialist,” he says. “In an endodontic world of complicated file systems, practitioners must often use 6-10 files to get down to the apex and enlarge canals appropriately. We have heard only positive feedback from our Chicagoland Smile Group dental team about the TF™ Adaptive system’s ease of use and zero-file separation, and the resultant decreased patient chair time during endodontic therapy.”


Chicagoland Smile Group
Dentist and entrepreneur Dr. Roshan Parikh is the founder and president of Chicagoland Smile Group. His vision is to build a best-in-class dental support organization in the Chicago area, offering dentists and dental specialists the opportunity to focus on the clinical aspects of dentistry, providing exceptional care for every patient. Since 2008, the group practice has grown to include a network of 12 multi-specialty dental practices with 45 dentists and dental specialists, all dedicated to advancing dental healthcare in the greater Chicago area.


TF™ Adaptive system

With TF™ Adaptive by Kerr Endodontics, dentists and dental specialists can count on predictability, durability and flexibility. The intuitive color-coded system ensures peace-of-mind for new and experienced clinicians alike, enabling them to focus on providing an efficient, successful root canal treatment and an optimal patient experience. Key features include:

  • Adaptive motion technology. Adaptive Motion incorporates a patented feedback algorithm, designed to change the motion of the file based on the applied load, or stress. When there is minimal stress on the file, the system provides a rotary (clockwise) motion. As the file cuts more dentin, the motion automatically transitions to reciprocation (counterclockwise), preventing the file from grabbing too much of the canal wall. As the stress increases or decreases, the motor responds accordingly, ensuring precision and success.
  • Flexibility. Designed with R-Phase technology, TF™ Adaptive files are up to 70 percent more flexible than other file brands, enabling clinicians to comfortably navigate curved canals and decreasing the risk of canal transportation.
  • Durability. TF™ Adaptive files are twisted – not ground – into shape, reducing the risk of microfractures and file separation. The unique design ensures files are up to 58 percent more resistant to fracturing than other leading brands. Removing the uncertainty from root canal treatment permits dentists to work more efficiently and focus on an ideal patient experience and exceptional results, leading to a stronger relationship with the communities they serve.

The Ethical Choice

Sponsored: KaVo Kerr

A great handpiece design makes it easy for dentists to follow sterilization protocols.

Sterilization best practices have long been considered key to providing safe, ethical patient care. In the past 10 years, infection control experts have added dental handpieces to the list of instruments that present a risk of cross-contamination. “For many years, we have been aware that reusing a dental handpiece without autoclaving it can place patients at risk,” says Noel Brandon Kelsch, M.S., a registered dental hygienist in alternative practice and a key opinion leader for KaVo Kerr. “Related studies have repeatedly shown that both high- and low-speed handpieces that are not autoclaved can be a source of cross-contamination.” (Chin JR, Miller CH, Palenik, CJ, Internal contamination of air-driven low-speed handpieces and attached prophy angles. J Am Dent Assoc. 2006 Sep; 137(9): 1275-80.) In fact, such studies have demonstrated that, even with the use of a simple prophy angle the internal unit of the handpiece can become contaminated, increasing the risk of cross-contamination, she adds.

Infection prevention guidelines in dental practices
In its 2008 Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care, the Centers for Disease Control and Prevention (CDC) points out that handpieces can be contaminated internally with patient material and therefore should be heat sterilized between patient use. “Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles, should always be heat sterilized between patients and not high-level or surface disinfected,” states the CDC. “Although these devices are considered semicritical, studies have shown that their internal surfaces can become contaminated with patient materials during use. If these devices are not properly cleaned and heat sterilized, the next patient may be exposed to potentially infectious materials.”

“Debris, bacteria and viruses are harbored internally in the handpiece,” adds Kelsch. “All available studies demonstrate that clinicians put their patients at risk when they fail to sterilize the handpiece between uses.”

Addressing the challenges
When efficient sterilization processes are in place, the dental practice saves time and money. With the right design, dental handpieces can be sterilized quickly and effectively. Clinicians should look for a handpiece with the following features, according to Kelsch:

  • Sleek design, making it easy for clinicians to grip.
  • Smooth, gapless surfaces, preventing debris and bacteria from collecting.
  • Resilient finish, such as titanium, which withstands chemicals and the sterilization process better than chrome plate.
  • Easily taken apart for simple reprocessing.
  • Easy-to-follow instructions for use.

A good handpiece is well worth the investment, notes Kelsch, especially considering that a single handpiece may last up to 1,000 patient visits. A higher-end, well-designed handpiece that is easier to use and facilitates faster sterilization can lead to reduced time in the chair for patients, she points out, resulting in greater patient – and staff – satisfaction throughout the practice.


SMARTmatic Series

KaVo Kerr’s SMARTmatic Series handpieces are designed for comfort, easy use and efficient sterilization, enabling clinicians to follow CDC sterilization guidelines and ensure their patients’ safety and comfort. The air-driven handpieces feature a high power, precision-balanced turbine for optimum balance and virtually vibration-free operation, and provide reliable performance during crown and bridge preparations.

Features include:

  • Stainless steel, rustproof construction, enhancing the life of the handpiece.
  • One-piece handpiece sleeve with no gaps or edges, eliminating the need to disassemble before sterilization and making cleaning easier.
  • Ball bearings for smooth operation.
  • Smaller head size for improved sight lines.

KaVoTM ELECTROmaticTM System

Sponsored: KaVo Kerr

KaVoTM ELECTROmaticTM System

  • Primary function:
    • Air-to-electric electric upgrade system with dual motor and endo options.
  • Life of equipment:
    • KaVo’s trusted quality – together with a 3-year warranty and modular system for easy replacement of water filters and tubing – ensure the ELECTROmatic delivers versatility, excellence and comfort.
    • KaVo’s MASTERmatic and EXPERTmatic electric handpieces come with a two-year warranty, which can be extended to 2.5 years when maintained with a QUATTROcare plus maintenance system.
  • Repair or replace?
    • The ELECTROmatic system’s modular design allows for easy technician-free part replacement for water filters, LED bulbs and tubing.
  • How it works:
    • By combining the new KaVo ELECTROmatic with KaVo’s industry-leading electric handpieces and a short, powerful, lightweight motor, KaVo provides an ideal solution for synchronized efficiency.

What you need to know:
The KaVo ELECTROmatic is available in three models, which means there is an electric solution for every dental office. The ELECTROmatic is the first dual-motor electric retrofit system in North America.

  • With 20 pre-programmed endodontic file systems and reciprocal movement, the ELECTROmatic Premium offers a true all-in-one electric platform.
  • Improvements to the technology:
    • ELECTROmatic control box:
      • Dual motor option.
      • Dentists can choose remote mount display for the best ergonomic viewing position.
      • Over 20 preprogramed endo file systems.
      • SMARTdrive sensorless control allows a high torque at low-speed ranges.
    • MASTERmatic handpiece:
      • KaVo has paired the ELECTROmatic with the MASTERmatic LUX M25 L and the MASTERmatic LUX M05 L Mini High-speeds, which combine small head size with powerful and quite performance. The MASTERmatic high-speed attachments feature a triple-gear system for smooth, reliable operation and patented angles for superior access.
  • COMFORTdrive handpiece:
    • KaVo’s most innovative handpiece – the COMFORTdrive 200XDR – offers a blend of optimal performance and superior ergonomics, with nearly silent operation. Thanks to integrated micromotor technology, COMFORTdrive delivers the precise cutting performance of an electric handpiece, with a light-weight, ergonomic design similar to that of an air-driven handpiece.
  • KL703 LED short motor
    • The KL703 LED brushless electric motor is 30 percent lighter and 25 percent shorter than other market leading electrics. Paired with KaVo’s ELECTROmatic systems, it connects with any attachment with ISO 3694 (E-style) connection.
  • Price range:
    • $1,899-$4,199 MSRP.

KaVo ELECTROmatic Highlights

  • KaVo’s ELECTROmatic provides the most recent improvements in electric handpieces.
  • With three models from which to choose, the KaVo ELECTROmatic offers an electric solution for every office.
  • KaVo’s ELECTROmatic SAFEdrive feature, MASTERmatic handpiece quality and the QUATROcare maintenance system have addressed any overheating concerns.
  • The KaVo KL703 short motor and COMFORTdrive, together with the MASTERmatic M25L and M05L, address any heavy or bulky handpiece concerns.
  • KaVo quality handpieces provide the dental practice with versatility, excellence and comfort.
  • With three models from which to choose, the KaVo ELECTROmatic offers an electric solution for every office, no matter what its needs and budget is.

The Ideal Cure

By Laura Thill

As curing technology has become increasingly sophisticated, curing lights have become more and more diverse, leading dentists to question which light solution and bulk fill composite best meets the needs of their practice.

Shashikant Singhal

Curing lights today are an integral part of modern dentistry, notes Shashikant Singhal, BDS, MS, director of professional services, Ivoclar Vivadent, Inc. “Nowadays, curing lights are used not only to polymerize dental composites, but also to cure dental adhesives; resin cements in various clinical situations, like curing through ceramic restorations; post and cores; and deep restorative cavities,” he says. “Therefore, to provide an ideal restoration with long-term clinical success, it is critical for a clinician to select a curing light that meets all the requirements.” Curing light technology features quartz-tungsten halogen, plasma arc, argon laser and most contemporary LED curing lights, he adds. But, that begs the question: How can dental providers determine the ideal curing light solution for the needs of their practice?

The science behind the cure
The rapid changes in light curing technology in recent years – and the impact this has had on the chemistry of light-cured resin-based materials – makes it more important than ever for dentists to fully understand the curing process, as well as challenges. “Clinicians must understand the chemistry of the composite, their curing lights and the polymerization technique, as inadequate polymerized composite restorations tend to show high wear, chipping, catastrophic fracture and compromised esthetic by staining,” says Singhal.

For starters, light cured resin-based materials consist of a number of ingredients, including resin matrix; filler particles coupled with matrix, using coupling agents; and photo-initiators, according to Singhal. “The photo-initiators absorb light energy of specific wavelengths from curing light units,” he explains. “The energy absorbed excites the molecules and enables the formation of free radicals; this, in turn, initiates polymerization.” For years, clinicans relied on the photo-initiator, Camphorquinone, he points out. However, Camphorquinone has a yellowish color, prompting the use of lighter colored initiators, such as Lucirin TPO and phenyl-propanedione (PPD). Recently, Ivoclar Vivadent patented a new photo-initiator, Ivocerin, designed for use in bulk fill technology and color stable resin cements.

When purchasing a new curing light, Singhal looks for light units that offer a broad wavelength spectrum, high power intensity and a homogenous beam profile – attributes that ensure the curing light unit will adequately polymerize all resin-based material, he notes. “Photo-initiators absorb light energy of a specific wavelength spectrum to facilitate the polymerization,” he says. “Most – but not all – contemporary LED curing lights have a narrow wavelength spectrum of 430 – 480 nm. The absorption spectrum of Camphorquinone (CQ) is between 390 – 510 nm, and Ivocerin is between 370-460 nm.” By comparison, Lucirin TPO and PPD absorb light in the range of less than 430 nm, and the materials may not be cured properly using a narrow spectrum LED curing light, he adds.

It’s also important to consider the amount of energy required to adequately polymerize the material, says Singhal. “This is calculated by the power intensity of a curing light exposed over a period,” he explains. To ensure adequate polymerization, most manufacturers recommend between 10 and 20 seconds of light polymerization for a resin composite, with a curing light power intensity of 1000 mW/cm2. “The light units with lower power intensity can result in compromised polymerization of a resin composite,” he points out.

Finally, it is also critical to have uniform distribution of light – or beam homogeneity – at the end of the curing light probe to ensure the composite material is uniformly and adequately polymerized, he says. “A non-uniform distribution of light energy results in localized hot spots of adequate energy, resulting in inadequate polymerization of the remaining exposed composite surface. These lights tend to be more economical, but they have limitations, such as a non-homogenous beam profile or a narrow spectrum, which can compromise the clinical outcome.”

Ivoclar’s Bluephase® Style curing light from Ivoclar Vivadent meets Sighal’s standards for wavelength spectrum, power intensity and a homogenous beam profile. “Bluephase Style curing lights are equipped with advance polywave light emitting diode technology, enabling them to achieve an optimal broad spectrum wavelength range from 385 – 515 nm, with high power intensity of 1,200 mW/cm2,” he says. “Polywave technology serves as a benchmark for many clinicians, as it enables them to cure all dental restorative materials with different photo-initiators systems (e.g. Camphorquinone, Lucirin TPO, phenylpropanedione (PPD), Ivocerin etc.). Additionally, Bluephase Style curing lights are equipped with a parallel light guide, which helps reduce light-intensity loss when the light guide needs to be held at distances from the material to be irradiated.” The Bluephase Style’s light guide, in combination with the unit’s ergonomic pen design, ensures easy access to the entire mouth, he adds.

Myths and challenges
Few non-surgical restorative procedures today do not require the light polymerization of dental materials. “While there has been much attention to the details of diagnosis, clinical procedures and the development of improved adhesives and resins, light polymerization is often taken for granted,” says Singhal. Some clinicians may not fully understand the curing process, he notes. “Not all curing lights are the same, and not all hard materials are completely polymerized, and it’s important that dentists be aware of this,” he says.

Indeed, there is much variance from one curing light to another, Singhal points out. Higher end curing light units, designed with a higher quality LED curing light, tend to provide consistent power output over longer periods of time, he notes. It’s equally important for dental offices to measure power output of their curing lights regularly. “Dental manufacturers invest in a high-quality radiometer devices like an integrating sphere, which can measure power output of a curing light with accuracy of ± 5 percent, however these devices are expensive,” he adds. “Other less expensive chairside radiometers are also available.”

Again, dentists get what they pay for, and the less expensive, conventional hand held radiometers fail to provide accurate light intensity measurements, in his opinion. “Most handheld radiometers are only capable of measuring power output over a small area of the probe, resulting in an inaccurate or false reading,” he says. “In contrast, Ivoclar Vivadent’s Bluephase® meter II features a surface sensor, permitting the meter to measure power output over the radiating surface of the curing light probe with an accuracy of ± 10 percent.”

Investing in higher end equipment and materials not only helps ensure optimal results, it often saves dentists – and patients – time, Singhal notes. For instance, using traditional resin-based filling material requires a longer time to polymerize increments of composites, while restoring deep cavities, he says. “Factors such as air bubbles, compromised adaptation of layers, contamination and heat generation from multiple polymerization cycles during the restorative procedure can further compromise the clinical outcome,” he explains. “Other factors, like composite shades and translucencies, can also affect the light polymerization reaction. Lab studies have shown that darker, opaque dentin shades require higher light energy for polymerization compared to lighter, more translucent enamel shades. Conventional initiator systems alone are unable to cure increments exceeding 1.5 – 2 mm. So, it’s critical that clinicians consider all variables during polymerization of these materials.”

Bulk fill composites
Dentistry is quickly changing, notes Singhal, and with that comes the availability of increasingly efficient products – including bulk fill composites. “These materials have higher depth of cure compared to conventional composites and allow clinicians to restore cavities in thick increments of 4-5 mm, decreasing chairside time without compromising clinical outcome.” Dental manufacturers can achieve an increased depth of cure by increasing either the concentration of photo-initiators, curing time or translucency of the material, he says. “Increasing the concentration of photo-initiators and polymerization time will enhance reactivity of the material to light energy, whereas increased translucency allows deeper light penetration to achieve a higher depth of cure,” he explains. That said, increasing photo-initiator concentrations can decrease working time, while an increased polymerization time means greater heat generation from the curing light unit and a longer chairside time, and increased translucency can compromise the esthetics of the restoration.

Unlike conventional approaches, which employ a composite layering technique, Ivoclar Vivadent’s Tetric® EvoCeram Bulk Fill composite – a light cured composite indicated for direct restorations in posterior teeth and for class V restorations – has a sculptable viscosity and is formulated to be light polymerized in bulk increments of up to 4 mm, notes Singhal. “The time required to adequately polymerize this material from a light curing unit with an intensity greater than 1000 mW/cm2 is only 10 seconds,” he says. “Tetric EvoCeram Bulk Fill includes a patented light initiator/polymerization booster, Ivocerin, for a high depth of cure. It combines advanced composite-filler technology to achieve the desired mechanical properties and high surface finish; a pre-polymer shrinkage stress reliever to minimize polymerization shrinkage stress; and a light sensitivity filter for adequate working time.

“Ivocerin is truly an innovation in photo-polymerization technology,” he continues. “Traditional photo-initiator systems, such as Camphorquinone, have limitations, such as low quantum efficiency (low sensitivity to light). In addition, the use of amine-based co-initiators with Camphorquinone may cause discoloration of composite material due to the oxidation of the remaining amine component. To overcome these challenges, and to innovate an ideal photo-initiator technology for contemporary bulk fill materials, Ivoclar Vivadent collaborated with Professor R. Liska of the Vienna University of Technology to develop and patent the germanium-based photo-initiator, Ivocerin. Unlike conventional photo-initiators, Ivocerin is approximately ten times more reactive to the curing light, thereby requiring less light energy. The absorption spectrum of Ivocerin ranges from 370 nm – 460 nm, so light can be activated using commercially available curing light units. And, Ivocerin’s amine free chemistry ensures that composite materials are highly color stable.”

For Ivoclar Vivadent Inc., innovation comes down to the ability to perfect strategies, products and services, Singhal points out. “We strive to anticipate our customers’ needs, and we continually challenge our research and development team to find better, more effective and efficient solutions to meet clinicians’ requirements.

“Ivoclar’s research and development team includes chemists, researches and well-trained dental professionals, who understand what dentists truly need to run a successful practice,” Singhal says. “Once a product is developed, our team creates educational content, such as scientific literature and animated and clinical tip videos, which are available on the Ivoclar Vivadent North American website.”  These resources – as well as online training sessions – are available to dentists, as well as their staff and their distributor sales reps, he adds. “Our longtime customer service support, which includes experienced clinicians, registered dental hygienists/assistants and trained customer service representatives, is always available. We mean it when we say, ‘Customer satisfaction is guaranteed!’”

Instructions for Use

Infection Control

Katherine Schrubbe, RDH,
BS, M.Ed, PhD, is director of quality assurance at Milwaukee, Wisc.-based Dental Associates.

By Katherine Schrubbe

What they are and why they are important to the dental practice

When you purchase a new car, you find the time to read and review every page of the ½-inch-thick owner’s manual to ensure the new vehicle runs at peak performance. When you purchase a new television for the dental reception area, you unfold the thin accordioned sheets of diagrams to review the set-up and ensure that each connection jack has the correct cords plugged in, prior to turning it on for viewing. So why do dental healthcare personnel discount – or even ignore – instructions for use (IFU) that accompany medical/dental devices or products used in the dental practice? In fact, does everyone in the practice even know what IFU stands for and why it’s important? 


IFUs are provided for medical devices and products in accordance with federal Food and Drug Administration (FDA) standards. In October 1982, the FDA merged the Bureau of Medical Devices and the Bureau of Radiological Health to establish the Center for Devices and Radiological Health (CDRH). The Center develops and implements national programs to protect the public’s health in the fields of medical devices and radiological health. These programs are intended to assure the safety, effectiveness and proper labeling of medical devices; control unnecessary human exposure to potentially hazardous ionizing and nonionizing radiation; and ensure the safe, efficacious use of such radiation.1

In an ever-increasing society of litigation, dental healthcare personnel must be aware of, educated and accountable for the proper use and maintenance of medical/dental devices utilized in the dental practice. In large group practices and DSOs, where there are greater numbers of staff, calibration and team members to be trained, it is vital that the IFU are a key component of patient care and staff safety. Everything from sterilizers to hand-held x-ray equipment, chemical indicators and more contain IFU, which must be explicitly followed for peak performance of the device.

Part of the FDA’s mission is to protect the public’s health by assuring the safety, efficacy and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics and products that emit radiation.2 In the daily routine of dental practice, most dental team members are primarily focused on CDC and OSHA compliance and may not realize how great an impact the FDA makes.

On March 17, 2015, the FDA released “Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling Guidance for Industry and Food and Drug Administration Staff.” The document not only superseded the April 1996 guidance titled, “Labeling Reusable Medical Devices for Reprocessing in Health Care Facilities: FDA Reviewer Guidance”, but included an appendix (E) that was updated June 9, 2017.3 Let’s take a brief review of the highpoints of this document as it relates to reprocessing reusable devices in the dental practice.

For starters, the 2015 FDA guidance focuses on the importance of stated methods for reprocessing reusable/reprocessable devices, sterilization parameters and labeling requirements for manufacturers submitting devices for 510(k) clearance. A 510(k) requires demonstration of substantial equivalence to another legally U.S. marketed device; substantial equivalence means that the new device is at least as safe and effective as the predicate. The guidance document applies not only to new devices, and exemption from 510(k) does not mean a device is exempt from compliance with labeling or quality system requirements.4 The updated 2015 guidance states that for reusable medical devices, validated reprocessing instructions are expected from the manufacturer.3

Section 6 of the 2015 guidance document lists six criteria manufacturers should include in their IFU to ensure users – in this case, dental team members or dental healthcare personnel – understand, implement and facilitate the IFU correctly:

  • Criterion 1: Labeling should reflect the intended use of the device. This includes how and where the device is used. For instance, is it only used on skin? Mucosal surfaces? Sterile tissues of the oral cavity? The label should state the reprocessing method that reflects the physical design of the device, its intended use and the soiling and contamination to which the device will be subject during clinical use.3 This provides the DHCP with the information needed to use the device as intended; it is not acceptable to make a subjective decision on device usage once the manufacturer and FDA have made this determination.
  • Criterion 2: Reprocessing instructions for reusable devices should advise users to thoroughly clean the device. Cleaning is the most important step in the instrument processing cycle.5 The criterion here states that instructions to the user should clearly communicate how to achieve thorough cleaning and that details of the cleaning procedure will vary depending on the complexity of the device.3 From the user perspective, the CDC recommends that dental team members assigned to sterile processing areas be trained and understand the importance of cleaning instruments prior to disinfection or sterilization.6

CDC Key recommendations for sterilization and disinfection of patient-centered devices for dental setting.6

  • Criterion 3: Reprocessing instructions should indicate the appropriate microbicidal process for the device. In this section, the guidance states that the method for reprocessing should be consistent with current infection control protocols and that whichever reprocessing method(s) is recommended, the compatibility of the device with the method(s) and the ability of the method(s) to successfully reprocess the device features should be validated and then stated in the instructions for use.3 Dental team members must read and understand the IFU for sterilizer cycle times and temperatures.
  • Criterion 4: Reprocessing instructions should be technically feasible and include only devices and accessories that are legally marketed. This criterion, which was intended as a recommendation for manufacturers to provide the dental team with streamlined, understandable IFU, can actually be quite confusing. It’s intended to ensure that the method for reprocessing the device includes the equipment and accessories needed to implement the instructions, which should be clearly defined. In short, manufacturers should not come up with unreasonable methods or obscure devices needed for the reprocessing of their device. “The FDA recommends that the instructions specify sterilization methods and parameters that are technically feasible for the user. That is, sterilization cycle parameters specified in the labeling for reprocessing a device should be consistent with validated sterilization cycle parameters for commonly available, legally marketed sterilizers.”3 This is demonstrated in the sterilizer manufacturer market, where manufacturers are required to meet AAMI standard cycles to ensure IFU for sterile packaging systems don’t conflict with IFU for sterilization indicators used to monitor their cycles.7

Association for the Advancement of Medical Instrumentation.8

  • Criterion 5: Reprocessing instructions should be comprehensive. This lengthy criterion outlines each segment of the reprocessing steps in detail. It states that the instructions should describe any accessories that are needed for safe reprocessing, and notes whether personnel need any special protection for personnel during reprocessing.3 When the dental practice obtains new equipment or devices, it is critically important to review the IFU and follow the detailed steps for reprocessing without shortcuts. Since the IFU have been validated, compliance will provide the intended and expected results.
  • Criterion 6: Reprocessing instructions should be understandable. Simply stated, the IFU should “be clear, legible (i.e., reasonable font size) and provided in sequential order from the initial processing step through the terminal processing step.”3 The criterion also states that IFU should be written in “simple” language and that charts, diagrams and pictures can be helpful to end users working to comply with them. If the practice obtains new a sterilizer with an accompanying cycle chart, it is a great idea to post this information in the sterilization area for dental healthcare personnel to refer to. This way, all team members have access and there is no question or confusion about how to use the sterilizer.

Older, legally-marketed reusable devices with IFU prior to the 2015 guidance may not be consistent with state-of-the-art science, according to sources such as the FDA and Andrew Steen, CDRC Senior Lead Reviewer, Dental Devices Branch. Labeling alone is not sufficient to ensure these devices are clean, disinfected or sterile, and the purity or quality of the device may fall below that which it purports or is represented to possess.9 In addition, the device may be misbranded such that labeling does not bear adequate IFU and the device is dangerous to health.9

The CDC and FDA agree that devices absent of IFU should be considered single-use – used on a single patient and then disposed of appropriately. This includes dental burs and endodontic files.6,9 For current practice, these devices should be considered single-use, notes Steen. In the future, if the manufacturer has IFU that meet the 2015 guidance, it should be followed. If there are no IFU, or if they are incomplete, clinicians should continue to consider them single-use.9

Given the constant stream of new and emerging technology today, and the numerous medical/dental devices currently used in dental practices, IFU should continue to play an important role. The FDA 2015 guidance has set strong recommendations, including clear expectations, for manufacturers. Dental healthcare professionals must be aware of the devices in their practice, and understand and carry out the appropriate IFU. All dental team members – especially those assigned to instrument reprocessing – must take their role in this process very seriously.

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


References:

  1. US Department of Health and Human Services. Public Health Service Food and Drug Administration. Labeling – regulatory requirements for medical devices. HHS Publication FDA 89-4203. https://www.fda.gov/downloads/medicaldevices/deviceregulationandguidance/guidancedocuments/ucm095308.pdf. Accessed September 27, 2017.
  2. US Department of Health and Human Services. Public Health Service Food and Drug Administration.  FDA Mission Statement. https://www.fda.gov/downloads/aboutfda/reportsmanualsforms/reports/budgetreports/ucm298331.pdf. Accessed September 27, 2017.
  3. US Department of Health and Human Services. Public Health Service Food and Drug Administration.  Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling Guidance for Industry and Food and Drug Administration Staff. March 17, 2015. https://www.fda.gov/downloads/medicaldevices/deviceregulationandguidance/guidancedocuments/ucm253010.pdf.  Accessed September 27, 2017.
  4. US Department of Health and Human Services. Public Health Service Food and Drug Administration.  https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/HowtoMarketYourDevice/PremarketSubmissions/PremarketNotification510k/default.htm#when. Accessed September 27, 2017.
  5. Molinari JA, Harte JA. Cottone’s Practical Infection Control in Dentistry. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2010; 223.
  6. Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health, March 2016.
  7. Hughes C. Manufacturer’s IFU. What are they and why they are so important? OSAP Annual Symposium; Baltimore, 2015.
  8. Association for the Advancement of Medical Instrumentation. AAMI. http://www.aami.org/productspublications/ProductDetail.aspx?ItemNumber=1077.September 27, 2017.
  9. Steen AI. FDA Regulations and infection control in the dental setting.  OSAP Annual Conference; Atlanta, 2017.

Hit the Ground Running

The OSAP Dental Infection Control Bootcamp™ 2018 experience offers attendees an opportunity to enhance their infection control knowledge.

From the infection control coordinator to the industry sales representative, it’s critical for individuals in the profession to stay on top of the latest guidelines, regulations and strategies for infection prevention and safety in dental settings. The Organization for Safety, Asepsis and Prevention (OSAP) Dental Infection Control Boot Camp™, January 8 – 11, 2018, in Baltimore, Md., is an educational course covering a comprehensive curriculum in infection prevention and safety to support the Safest Dental Visit™. Serving as a crucial building block for every dental professional with infection control responsibilities, this training course takes the OSAP Boot Camp™ attendee through several engaging days of infection control education sessions, workshops and hands-on learning, provides interactive Q & A time with instructors and offers up to 24 hours of continuing dental education credit (CDE).

The attendee
The OSAP Dental Infection Control Boot Camp™ participant is a dental professional with infection control responsibilities, who is looking for a comprehensive curriculum in infection control and safety in dentistry. This program is perfect for infection control coordinators, infection prevention and safety educators, compliance officers in group practices and on dental boards, federal service employees responsible for infection control in their duty stations, Federally Qualified Health Center (FQHC) personnel, consultants and sales representatives.

Day one: Strategy, principles and theory
Attendees receive rich OSAP Dental Infection Control Boot Camp™ resources as they are prepared for three days of fast-paced learning and interactive education. Day one provides attendees with the principles and theory behind patient safety and introduces the role and responsibilities of the infection control coordinator. Important topics covered include infection control regulations, guidelines and standards, microbiology, antibiotic resistance and stewardship, OSHA bloodborne pathogens and hazard communications. Attendees are also exposed to their first Boots on the Ground session to put learning into action during exciting hands-on exercises.

Day two: Operations and management
During day two, attendees are guided through education designed to help translate theory into the everyday realities of dental settings. Experts in infection control lead attendees through topics that include personal protective equipment (PPE), proper hand hygiene, biofilms and waterlines, instrument processing and operatory preparation. There will also be another round of fast-paced Boots on the Ground sessions.

Day three: Application and innovation
As the program nears completion, Boot Camp attendees dive deeper and learn about important strategies and applications to take home. On day three, courses on exposure incident management, writing SOP’s, policy and program development, responses to infection control breaches and crucial document requirements offer tools and information that attendees can refer to when they get back to their dental settings. Attendees also benefit from the latest innovations and dental infection control solutions during the vendor product fair, and facilitators will be available to help them apply what they’ve learned in interactive workshops.

Bonus day four: Federal Service focus
Federal Services attendees will have additional training sessions on Thursday morning, January 11, covering topics specific to their guidelines, environments and opportunities. This may include the Air Force, Army, Navy, Coast Guard, Public Health Service and Veterans Administration attendees. Federal Service personnel may qualify for an additional 4 hours of CDE credit.

Experience the journey
Each OSAP Dental Infection Control Boot Camp™ is unique because of the diversity, engagement and camaraderie of the participants. Attendees will experience their own journey by registering for the 2018 OSAP Dental Infection Control Boot Camp™ today.
Deadlines and discounts for registration, hotel information and updates on the topics for the 2018 OSAP Dental Infection Control Boot Camp™ are available on OSAP.org. OSAP encourages everyone to register early for the greatest registration discounts. Registration closes on December 15, 2017.

To learn more about OSAP, its mission or becoming a member, visit OSAP.org today. While membership is encouraged, the Boot Camp event is open to non-members as well.

News

Western Dental acquires Kids Dental Kare
Western Dental (Orange, CA) acquired Kids Dental Kare (Los Angeles, CA), a provider of pediatric dental services in 14 California cities. With the new affiliation, Western Dental and its affiliated clinics operate more than 245 oral health clinics in California, Arizona, Nevada, and Texas.


Mid-Atlantic Dental Partners names new COO
Mid-Atlantic Dental Service Holdings LLC (Plymouth Meeting, PA), operating as Mid-Atlantic Dental Partners, named Leigh Feenburg as the company’s COO. As COO, Feenburg will be responsible for all dental operations and achievement of the company’s operational and financial goals. Feenburg previously was a VP of operations in Florida and Texas for Great Expressions Dental Centers. Additionally, Mid-Atlantic Dental Partners announced that Dr. Rob Samit will join the company’s board of directors. Dr. Samit is the founder of MyEyeDr.com.


Heartland Dental announces hurricane relief efforts
Heartland Dental (Effingham, IL) spearheaded a relief effort to help the company’s supported dentists and team members affected by Hurricanes Harvey and Irma. Heartland Dental has raised over $40,000 for its disaster relief fund to assist supported dentists and team members affected by natural disasters. Heartland Dental has also pledged to match up to $50,000 and has already donated 6,000 tubes of toothpaste and 7,500 toothbrushes to Harvey victims. Donations for Heartland Dental supported dentists and team members who have been affected are still being accepted.


Henry Schein hosts disaster-relief symposium
Henry Schein Inc (Melville, NY) joined the Texas Dental Association, the Texas Veterinary Medical Association, the Texas Veterinary Medical Foundation, and The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry to host an expert-led symposium to help healthcare professionals restore and reopen their practices post-natural disaster. The event was free for all healthcare professionals.


American Academy of Periodontology names new officers for 2017-2018 year
American Academy of Periodontology (AAP) (Chicago, IL) named Steven Daniel as president for the 2017-2018 year. Other newly installed officers include President-elect Richard Kao, VP Bryan Frantz, and Secretary/Treasurer James Wilson. AAP also announced it awarded members for their contributions and accomplishments both within the AAP and the specialty of periodontics. The awardees were honored at a ceremony during the AAP’s 103nd Annual Meeting, held September 9-12 in Boston, Massachusetts


Georgia Dental Association names new president
The Georgia Dental Association (Atlanta, GA) named Dr. Robin Reich as its 2017-2018 president. The GDA is a constituent of the American Dental Association. Reich has been member of the Georgia Dental Association since 1985 and held multiple officer positions at the district, state, and national levels.


Industry leaders launch Ventyv, new infection prevention company
Ventyv (Tampa, FL) is a recently established provider of infection prevention products. The company’s initial product launch is in the hand-protection category. Ventyv’s mission is to deliver superior infection prevention products that are consistently available to meet the demands of workers in the industries Ventyv serves. Ventyv will continue to supply Polymed latex exam gloves. Ventyv is a member of the Sri Trang Group. Its subsidiary, Sri Trang Gloves Thailand (STGT) is the manufacturer of Ventyv products. Billy Harris, CEO of Ventyv, is currently a board member of STGT and previously served as CEO for a Sri Trang joint venture in the hand protection category. Learn more at www.Ventyv.com


GEDC partners with Purpose Prep
Great Expressions Dental Centers (GEDC) (Southfield, MI) teamed up with Purpose Prep, an online education resource for American schools. GEDC will sponsor students in Detroit, Michigan as they undergo two of Purpose Prep’s hybrid e-learning courses. The program, which features classes taught once a week during regular school hours, will take place September 2017 through May 2018. GEDC also has provided 100 students with a backpack full of school supplies and dental products.


Light Wave Dental Management affiliates with Herbert Dental Group
Light Wave Dental Management (Woodbridge, VA), a portfolio company of affiliated funds managed by Alpine Investor (San Francisco, CA), recently affiliated with the Herbert Dental Group, which has offices in Leesburg and Purcellville, Virginia.


NIDCR names new deputy director
The National Institute of Dental and Craniofacial Research (NIDCR) (Bethesda, MD) named Douglas Sheeley, ScD, as new deputy director, effective October 16. Sheeley previously was senior scientific officer and acting chief of the Biomedical Technology Branch at the National Institute of General Medical Sciences.


ADA launches new credentialing service
The American Dental Association (ADA) (Chicago, IL) and the Council for Affordable Quality Healthcare (CAQH) (Washington, DC) launched a new credentialing service for all U.S. dentists. The service can let users know if licenses or documentation are set to expire. The ADA credentialing service, powered by CAQH ProView, enables dentists to enter professional and practice information in a secure digital platform, which lets them allow participating dental plans access to their information. The information can be used for credentialing as well as for provider directories, network adequacy, and other business needs. Automatic reminders to review profile information are sent every 120 days.


Delta Dental of Kentucky names new CEO
Delta Dental of Kentucky (Louisville, KY) named J. Jude Thompson as CEO. Thompson has served on the Delta Dental’s board since 2009 and has been its interim CEO since March 2017, when its previous CEO, Clifford Maesaka Jr., resigned.


Aspen Dental to open 3 new affiliated offices in Minneapolis, MN
Aspen Dental Management Inc (Syracuse, NY) announced it will open three new Aspen Dental-branded practices in Minnesota in October and November. Offices will open October 19 in Baxter, November 2 in Oak Park Heights, and November 9 in Willmar.


Dental Select names VP of sales and chief growth officer
Dental Select (Salt Lake City, UT) promoted Jeff Van Leeuwen to VP of sales and Suzette Musgrove to chief growth officer. In his new role, Van Leeuwen will work closely with and be responsible for all sales employees, building and identifying strategic business opportunities, and furthering the advancement of nationwide development. As chief growth officer, Musgrove will oversee all business development activities, including key General Agent partnership opportunities and distribution strategies.

Lasers in Hygiene

Heidi Arndt, RDH, BSDH has worked in the dental field for 18+ years. Her experience ranges from working as a treatment coordinator, dental assistant, and practice manager before graduating from the University of Minnesota with a bachelor’s degree in Dental Hygiene. In 2011, Heidi founded Enhanced Hygiene. She is dedicated to helping dental practices realize their total hygiene profit potential through the development of their hygiene team, quality patient care, patient-centric service and by empowering the entire team.

By Heidi Arndt

Have you considered?

Lasers have been utilized in the medical and dental environment for years. There are many benefits to utilizing lasers in dentistry compared to traditional treatment methods, or to enhance current treatment modalities. Technological advances have and will always evolve, and as clinicians seek to offer their patients the most up to date, technologically advanced treatment options, they should consider the use of a diode laser in the practice.

For treatment of periodontal disease, a diode laser is used as an adjunct to non-surgical periodontal therapy. This is performed as the dental laser tip is methodically maneuvered within the sulcus, in short overlapping strokes to aid in the destruction of the bacteria by creating an environment that the bacteria will not thrive.

Incorporating laser treatment
There are many ways to incorporate laser treatment into a dental practice. For use in the dental hygiene operatory the laser is used for bacterial reduction. With the growing knowledge of the etiology of periodontal disease, we want to focus on incorporating additional resources to our non-surgical periodontal therapy to ensure that we are reducing the bacterial load which will contribute to reducing the inflammatory response associated with periodontal disease.

In addition to bacterial reduction, lasers can also be utilized in guided-tissue regeneration, laser-assisted periodontal therapy and bio-stimulation. When introducing a new technology to patients, it is always recommended to inform the patients of clinical and radiographic findings, as well as incorporating a comprehensive medical history to assist in obtaining all necessary information to assess the patient’s risk for periodontal disease. With this information, you can begin to educate the patient on the newest ways to prevent, treat or maintain the current state of their oral cavity.

It is important to know that currently there is no long-term systematic research to support the use of lasers as an adjunct to non-surgical periodontal therapy, but we do know that there are clinicians utilizing diode lasers in accordance with their state dental hygiene practice acts with successful outcomes, such as increased wound healing and positive tissue outcomes. We truly believe future research will show the positive benefits of incorporating the diode laser as an adjunct to scaling/root planing, periodontal therapy and gingivitis therapy.

Explaining the service
Currently, there are no CDT codes specific to laser use, but it is possible to still provide the service by explaining to the patient that insurance does not currently recognize the procedure, which is often the case with newer technology. With our commitment to using the most up-to-date technology, we do are providing narratives to the respective insurance providers so they may understand the ever-evolving landscape of oral healthcare.

Without a specific CDT code available, many dental groups are using the D4999 (Un-specified Periodontal Procedure Code) to bill the procedure to the patient. As mentioned before, dental insurance is not recognizing a benefit for bacterial reduction at this point, which requires the dental group to pass the cost onto the patient.

Lasers and ROI
You may wonder if there is a true Return of Investment (ROI) to incorporating the diode laser into the dental hygiene operatory, and it is important to note a few things before considering your ROI.

  • No. 1: Do you have a strong and current periodontal therapy protocol in place for your practice? Is your team committed to recognizing periodontal disease and gingivitis at the earliest point?  With more than 50 percent of the U.S. population suffering from periodontal disease, you should see multiple periodontal patients/day in your practice for scaling/root planing and/or periodontal maintenance. Then also consider how many gingivitis patients would also benefit from laser use.
  • No. 2: Is your team comfortable and committed to discussing out-of-pocket expenses with your patients? As mentioned before, insurance does not offer a benefit for bacterial reduction using a diode laser. You will need to pass the fee onto your patient for this procedure.
  • No. 3: Commit to getting your entire team laser certified and educated on how to use the laser, and how to communicate the benefits of laser use to your patients. A strong training program and a supported implementation process will ensure your team is comfortable and confident with bring a laser into their standard of care.

Lasers are here to stay. We encourage all dental hygiene teams to look at the benefits of lasers and how they can integrate into their current practice.

If you have questions of how to integrate lasers into your dental group, please contact us today:

www.enhancedhygiene.com or hello@enhancedhygiene.com

 

 

 

Annaji, S. (2016). Efficacy of Photodynamic Therapy and Lasers as an Adjunct to Scaling and Root Planing in the Treatment of Aggressive Periodontitis – A Clinical and Microbiologic Short Term Study. Journal of Clinical and Diagnostic Research. doi:10.7860/jcdr/2016/13844.7165

 

Blayden, J., & Mott, A. (2013). Soft-tissue lasers in dental hygiene. Ames, IA: Wiley-Blackwell.

 

Convissar, R. A. (2015). Principles and Practice of Laser Dentistry. St. Louis, MI: Elsevier Mosby.

 

Fontana, C. R., Kurachi, C., Mendonça, C. R., & Bagnato, V. S. (2004). Microbial reduction in periodontal pockets under exposition of a medium power diode laser: An experimental study in rats. Lasers in Surgery and Medicine, 35(4), 263-268. doi:10.1002/lsm.20039

 

Harris, D. M. (2004). Laser antisepsis of Phorphyromonas gingivalis in vitro with dental lasers. Lasers in Dentistry X. doi:10.1117/12.549028