2018 OSAP Dental Infection Control Boot Camp™

Record breaking attendance reveals excitement for dental safety.

The Organization for Safety, Asepsis and Prevention (OSAP) – a  community of clinicians, educators, policy makers, consultants and industry representatives who advocate for the Safest Dental Visit™ – saw record breaking attendance for the 2018 Dental Infection Control Boot Camp™, held January 8-11, 2018, in Baltimore, MD.

The OSAP Dental Infection Control Boot Camp™ is a foundation-building educational course covering all the basics in dental infection prevention and control, as well as patient and provider safety. This year, over 480 dental infection control personnel from a variety of dental settings attended the course and were provided with resources, checklists and tools addressing foundational elements of dental infection control and safety.  Participants also had the opportunity to earn up to 24 hours of CE credit.

The multi-day course structure included educational sessions centered around the principles and theories of infection control on topics such as OSHA, exposure risk determination and bloodborne pathogens, microbiology and regulatory guidance. The program also highlighted the nuts and bolts of day-to-day management, with topics such as sterilization and disinfection of patient care items and dental unit waterlines.

The program’s interactive Boots on the Ground sessions helped to underscore application strategies through demonstration and hands-on exercises. Attendees also benefited from a vendor fair featuring over 25 dental infection and prevention companies and organizations, highlighting the latest dental safety and infection prevention technology, products and services. A distinct feature of the course was the esteemed faculty of infection prevention experts providing detailed lectures, followed by enriching Q & As to address questions and reflect on the dental infection control and prevention topics reviewed.

“Providing a crucial resource and outlet for professionals with infection control responsibilities to learn and engage is of utmost importance to OSAP and the Safest Dental Visit™,” says Christina Thomas, executive director of OSAP. “The success and growing interest in the 2018 program would not have been possible without the support of OSAP’s partners, dental infection control advocates, the innovation of our exhibitors and the guidance and expertise of our world class instructors. We will continue to provide an interactive and vibrant learning environment for course attendees and look forward to future courses.”

For attendees looking to take learning to the next level and enhance their knowledge of late-breaking infection prevention and control topics, policy developments and networking, OSAP offers an Annual Infection Control and Prevention Conference, May 31-June 3, 2018 in Dallas, TX. The conference is richly constructed, combining world class education with valuable networking activities.

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


Affordable Dentures & Implants to open three new affiliated practices
Affordable Dentures & Implants (Kinston, NC) will open several new affiliated practices. The office in North Lauderdale, Florida will open January 25. It is Florida’s 21st practice in the Affordable Dentures & Implants affiliated network. A new practice will open in Houston, Texas January 18. It will be Texas’s 25th practice in the Affordable Dentures & Implants affiliated network. A new practice in Silverdale, Washington will also open January 18. The dental practice will be Washington’s sixth practice in the Affordable Dentures & Implants affiliated network.

Aspen Dental practice in Erie moving to new location
The Aspen Dental practice in Erie, Pennsylvania is moving to a new location on January 22. The new office is one mile south of the current location. The new Erie office is one of 44 Aspen Dental practices in Pennsylvania.

CORDENTAL Group announces new affiliation
CORDENTAL Group (Cincinnati, OH) announced it affiliated with Terrence M. Major, DDS, and Chattanooga Dental Care. Dr. Major has been providing dental care to the Chattanooga, Tennessee area since 1984. This affiliation expands CORDENTAL’s footprint into Tennessee. Delta Dental of California awards $1.5M grant to UCLA School of Dentis try The UCLA School of Dentistry has received a $1.5 million grant from Delta Dental of California, the state’s largest dental benefits provider. The grant will support the launch of a community-based clinical education program. The award, which will support UCLA student dentists to care for some of the most vulnerable patients in California, is the largest that Delta Dental has ever given a dental school. The grant enables fourth-year dental students to treat Medicaid recipients or people who struggle with access to care. Two key healthcare delivery models that the school will affiliate with are federally qualified health centers and practices that focus on people living at or below 200% of the federal poverty level.

Western Dental names new chief marketing officer
Western Dental & Orthodontics (Orange, CA) named Leslie Gibbs as chief marketing officer. Gibbs previously held positions with Digital Branding Partners, Bonne Bell, LensCrafters, and Proctor & Gamble.

WalletHub releases list U.S. states with best and worst dental care
WalletHub recently released a report of U.S. states with the best and worst dental health. In order to determine which places have the healthiest teeth and gums in the U.S., WalletHub compared the 50 states and DC across 25 key indicators of dental wellness. The top states were: 1) Minnesota, 2) Wisconsin, 3) Connecticut, 4) Illinois, and 5) North Dakota. The five states at the bottom of the list were: 47) Montana, 48) West Virginia, 49) Alabama, 50) Arkansas, and 51) Mississippi.

Measuring Up

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

Spending on dental services, while on the rise, still accounts for only 4 percent of U.S. healthcare spending, according to the Centers for Medicare & Medicaid Services. Spending for dental services increased 4.6 percent in 2016 to $124.4 billion – a slight acceleration from 4.4 percent growth in 2015. Private health insurance, which accounted for 46 percent of dental spending, increased 4.8 percent in 2016 – the same rate of growth that occurred in 2015. Out-of-pocket spending for dental services, which accounted for 40 percent of dental spending, increased 4.3 percent in 2016 – a faster growth rate than the 3.4 percent increase in 2015.

The big picture
Total U.S. healthcare spending increased 4.3 percent to reach $3.3 trillion, or $10,348 per person in 2016, according to CMS. Spending growth decelerated in 2016 after the initial impacts of Affordable Care Act coverage expansions and strong retail prescription drug spending growth in 2014 and 2015. The overall share of gross domestic product (GDP) related to healthcare spending was 17.9 percent in 2016, up from 17.7 percent in 2015.

Spending by type of service or product in 2016 looked like this:

Hospital care (32 percent share). Spending for hospital care increased 4.7 percent to $1.1 trillion in 2016, slower than the 5.7 percent growth in 2015. The slower growth in 2016 was driven by the slower growth in the use and intensity of services, reports CMS. Hospital care expenditures showed mixed trends across the major payers, with slower growth in Medicaid and private health insurance spending, stable growth in Medicare spending, and faster growth in out-of-pocket spending.

Physician and clinical services (20 percent share). Spending on physician and clinical services increased 5.4 percent to $664.9 billion in 2016. Although growth for physician and clinical services decelerated slightly in 2016 (from 5.9 percent in 2015), it outpaced the growth in all other goods and services categories. The growth in the use and intensity of physician and clinical services was a driving factor in the overall growth in physician and clinical services, accounting for nearly three-quarters of the 5.4 percent increase.

Prescription drugs (10 percent share). Growth in retail prescription drug spending slowed in 2016, increasing 1.3 percent to $328.6 billion. The slower growth in 2016 follows two years of strong growth in 2014 and 2015, — 12.4 percent and 8.9 percent, respectively. This strong growth reflected increased spending on new medicines and price growth for existing brand-name drugs, particularly for drugs used to treat hepatitis C, says CMS. Growth slowed in 2016 primarily due to fewer new drug approvals, slower growth in brand-name drug spending as spending for hepatitis C drugs declined, and a decline in spending for generic drugs as price growth slowed.

Other professional services (3 percent share) Spending for other professional services reached $92.0 billion in 2016, an increase of 4.7 percent. This was a deceleration from the 5.9 percent growth in 2015. Spending in this category includes establishments of independent health practitioners (except physicians and dentists) that primarily provide services such as physical therapy, optometry, podiatry, or chiropractic medicine.

Other health, residential, and personal care services (5 percent share). This category includes expenditures for medical services that are generally delivered by providers in non-traditional settings such as schools, community centers, and the workplace; as well as by ambulance providers and residential mental health and substance abuse facilities. Such spending grew 5.3 percent in 2016 to $173.5 billion after increasing 8.7 percent in 2015. The slowdown was driven by the slower growth in Medicaid spending, 57 percent of all spending in this category, which slowed to 5.7 percent in 2016 after 10.8 percent growth in 2015.

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

Durable medical equipment (2 percent share). Retail spending for durable medical equipment, which includes items such as contact lenses, eyeglasses and hearing aids, reached $51.0 billion in 2016 and increased 4.9 percent, which was faster than the 4.1 percent growth in 2015.


Other non-durable medical products (2 percent share). Retail spending for other non-durable medical products, such as over-the-counter medicines, medical instruments, and surgical dressings, grew 4.4 percent (about the rate of growth in 2015, 4.6 percent) to $62.2 billion in 2016.

Who’s paying?
Meanwhile, CMS reports 2016 spending by major sources of funds:

  • Medicare (20 percent share): Medicare spending grew 3.6 percent to $672.1 billion in 2016, which was lower than growth in the previous two years when spending increased 4.8 percent in 2015 and 4.9 percent in 2014. The slower growth in 2016 was due to slower growth in spending for both the Medicare fee-for-service (2.2 percent in 2015 to 1.8 percent in 2016) and Medicare Advantage (11.1 percent in 2015 to 7.4 percent in 2016) portions of Medicare.
  • Medicaid (17 percent share): Total Medicaid spending decelerated in 2016, increasing 3.9 percent to $565.5 billion. This was much slower growth than in the previous two years, when Medicaid spending grew 11.5 percent in 2014 and 9.5 percent in 2015. The stronger growth in 2014 and 2015 was due in part to the initial impacts of the ACA’s expansion of Medicaid enrollment during that period. State and local Medicaid expenditures grew 3.2 percent, while federal Medicaid expenditures increased 4.4 percent in 2016.
  • Private health insurance (34 percent share): Private health insurance spending increased 5.1 percent to $1.1 trillion in 2016, which was slower than the 6.9 percent growth in 2015. The deceleration was largely driven by slower enrollment growth in 2016 after two years of robust enrollment growth due in part to ACA coverage expansion.
  • Out-of-pocket (11 percent share): Out-of-pocket spending grew 3.9 percent in 2016 to $352.5 billion, faster than the growth of 2.8 percent in 2015. This was the fastest rate of growth since 2007 and exceeded the average annual of growth 2.0 percent from 2008-15.

Source: Centers for Medicare & Medicaid Services, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf

How to Win Other People Over

By Lisa Earle McLeod

Would you ever stand in the way of a rocket going into space? Do you want to hold your country back, or help it move forward?

These are important questions. They’re examples of how the milieu creates the meaning.

Milieu is the social conditions and events that provide a backdrop in which someone acts or lives. Tapping into the right milieu is the secret to winning people over and getting big things done.

In the movie Hidden Figures three African-American women are broken down on the side of a lonely road in rural Virginia. The year is 1961. The three women work as “computers” at NASA doing calculations to put a rocket into space.

Unable to start their car, three black women in Virginia are understandably nervous when a police cruiser drives up. The officer, billy club in hand, approaches. He’s condescending and downright hostile until the moment Katherine says, “We’re on our way to work at NASA. Yes sir, getting our rockets into space.”

The officer’s entire countenance changes. He moves from hostile to helpful. He fires up his siren and gives the ladies a police escort to Langley.

Why the change in attitude?

The officer’s hostility quelled because he wanted to be part of something bigger than himself. He didn’t want to be the guy who caused his country to lose the space race.

The scene may be fictionalized, but the overarching story is true.

John F. Kennedy set a big audacious goal, put a man on the moon. He rallied the country around beating the Russians. The ladies in Hidden Figures used that lens to their advantage.

The social context of the times was terrifying for African-Americans. The officer’s social programming was likely racist, thus his immediate reaction to the ladies, was hostile. Instead of reacting, the NASA computers skillfully changed the frame through which they were viewed. They tapped into a different milieu.

Set the tone
How can you use this concept in your own work?

In an ideal world you’re Kennedy. You set the tone, you create the big audacious goal and you remind people of it every day. You provide the context and meaning for the work.

But we don’t all live in an ideal world. Maybe you’re living with hostility or prejudice. Or maybe you’re dealing with apathy and ignorance. In real life, the three women computers, Katherine Johnson, Dorothy Vaughn and Mary Jackson, were diminished and harassed. Yet, they prevailed.

Instead of playing small, they played big. Instead of succumbing to the social expectations of the times, they set their sights on a different reality.

They positioned themselves in the service of something of importance to people in power. It’s an important lesson.

If you want to win people over, cast yourself as a vital force for advancing a cause they care about. Watching the three women in Hidden Figures walk the line between deferential and engaging is both painful and inspirational.

It’s painful to think about genius having to be subservient in order to serve. Yet the true story is inspirational. Johnson, Vaughn Jackson and others advanced scientific discovery, and they moved the needle socially for the generations who came behind them.

The milieu is always moving. We are the ones who create it, and we are the people who decide which aspect of the milieu we want to tap into.

You can help launch the rocket. Or you can be the one who accepted the barriers.

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

Waterline Treatment/Hu-Friedy

The quality of dental unit water has been a topic of discussion and research for many years. Indeed, outbreaks of infection linked to the dental waterline can be a health risk for patients and a liability risk for dental practices.

It’s the ethical and professional responsibility of dental practitioners to provide safe dental water to their patients, and manufacturers, such as Hu-Friedy, make it a priority to keep them informed and provide optimal solutions for helping clean and maintain water used at their dental practice. Hu-Friedy offers a number of educational resources, including live continuing education courses, articles, on-demand webinars, step-by-step guides and customer service support. (To view their online resources, please visit: http://www.hu-friedy.com/education/infection-prevention-resources.)

According to the 2003 CDC Guidelines, “Dental unit water that remains untreated or unfiltered is unlikely to meet drinking water standards (303-309).” Dentists have several options for ensuring safe water standards at their dental practice, such as the following:

  • Filtration devices with in-line filters to remove bacteria before water enters the handpiece or other devices attached to the waterline.
  • Independent reservoirs with chemical germicides or cleaners to remove microbial accumulations and prevent attachment of microorganisms, such as Hu-Friedy’s Team Vista Dental Unit Waterline Cleaner.
  • Devices or cartridges that provide a slow release of chemicals.

Whichever method is chosen, it is critical to monitor waterlines on a periodic basis to ensure their efforts and product are working.

Common misconceptions
Contrary to what some dental professionals may realize, ALL dental waterlines – regardless of how new or old they are – must be cleaned and maintained. According to the CDC, “Research has demonstrated that microbial counts can reach <200,000 colony-forming units (CFU)/mL within 5 days after installation of new dental unit waterlines (305), and levels of microbial contamination <106 CFU/mL of dental unit water have been documented (309,338). These counts can occur because dental unit waterline factors (e.g., system design, flow rates, and materials) promote both bacterial growth and development of biofilm.”

Additionally, it’s essential for dental offices to understand that ensuring their source water meets CDC standards is a two-step process that involves both cleaning and maintenance. To help prevent waterborne organisms from attaching, colonizing and proliferating on the inner surfaces of water tubing, a complete dental unit waterline system should be used. Complete systems to control the quality of water delivered to patients include both periodic cleaning AND routine maintenance.

The CDC offers several steps to help dentists ensure the safety of their dental water:

  • Use water that meets EPA regulatory standards for drinking water.
  • Consult with the dental unit manufacturer for appropriate methods and equipment to maintain the recommended quality of dental water.
  • Follow recommendations for monitoring water quality provided by the manufacturer of the unit or waterline treatment product.
  • Discharge water and air for a minimum of 20-30 seconds after each patient from any device connected to the dental water system that enters the patient’s mouth.
  • Consult with manufacturer on the need for periodic maintenance of anti-retraction mechanisms.

Editor’s note: Sponsored by Hu-Friedy.


Compliance a Must

Waterline Treatment

By Laura Thill

Waterline disinfection helps ensure a safe patient visit.

Improperly or poorly treated waterlines can place dental patients and staff at risk for infection, as well as create a liability risk for the practice. Some dentists may believe they are taking sufficient steps to reduce the risk, when, in fact, they are not. Using distilled water, cleaning bottles daily and refilling them with fresh water, and installing filters are not enough, according to experts. And, while waterline cleaner tablets provide a good start, total compliance is required each time the water bottle is filled, and often the practice doesn’t follow up to ensure tablet protocols are followed consistently.

Once the source water – whether it is tap, filtered or distilled – reaches the narrow bore tubing of the dental unit waterlines, a perfect storm for biofilm growth develops, notes Leann Keefer, RDH, MSM, director, educational and professional relations, Crosstex. At the same time, microorganism counts exceeding the recommended 500 CFU/mL in the DUWL conflicts with the standard best practices of infection prevention and control. “Waterborne pathogens exist in all forms of water that are not sterile, including distilled,” she says. “To quote a highly respected colleague, Dr. John Molinari, ‘If you’re not doing anything to treat the dental unit water, it’s contaminated!’” Ignoring water line treatment is neither ethical nor acceptable, she adds.

“Dental unit waterlines (DUWL) must be effectively and efficiently treated to maintain acceptable safe and approved colony-forming-unit (CFU) counts,” Keefer continues. “For the past 50 years, Crosstex has been committed to focusing on safer patient care through innovative, high-quality solutions to ensure maximum compliance, in addition to offering an outstanding patient experience. It is critical for a client to understand the science behind the product, as well as following the validated product instructions for use (IFUs) for best performance.”

Indeed, the performance of a product is only as good as the accuracy of implementation according to the product IFUs, Keefer continues. “Compliance with DUWL treatment and the manufacturer’s IFUs is an important safety issue for the patient, staff and practice. The IFUs address the comprehensive DUWL treatment protocol, which may include the product as well as issues of frequency related to shocking recommendations and monitoring of CFU count. If a practice is only implementing one of three recommended steps or compromises on the frequency of treatment, the product is not being used in accordance with the IFUs.” (Daily-use products have a detailed list of protocols, which must be followed daily, weekly and quarterly to assure effective treatment outcomes.)

Addressing best practices
As a leader in infection prevention and control, Crosstex is committed to scientifically based programming to address best practices of infection prevention to provide a safe dental visit for the patient, clinician and the practice, says Keefer.  Indeed, the company is a big believer in providing its dental customers with strong educational programs and sound solutions to help them protect their patients and staff.

There are several DUWL treatment options available to dentists, including:

  • Routine chemical shocking protocol.
  • Tablet protocol.
  • Cartridge delivery protocol.

“While each method, used in compliance with IFUs, can be effective in managing CFU count, automated treatment with the annual installation of a Crosstex DentaPure® cartridge provides continuous treatment for dental unit waterlines, reducing the need for daily or weekly intervention,” says Keefer. “DentaPure cartridges reduce staff time while increasing compliance with protocol, decreases the incidence of human error, and reduces the exposure of the staff to potentially caustic and toxic chemicals.” Together with DentaPure cartridges, Crosstex Liquid Ultra® Solution helps ensure compliance with EPA standards for potable water, she adds. “DentaPure cartridges are EPA registered to provide water =200 CFU/mL. And, when used as directed, Liquid Ultra is EPA registered to provide water =500 CFU/mL and it reportedly is the only EPA approved in-line product that kills biofilm bacteria,” she says.

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

Easy maintenance
Dentists appreciate the value of infection control protocols, including waterline treatment. But, some may express concerns about managing the compliance process and maintaining records. Once installed, however, the DentaPure cartridge requires no monitoring or shocking for 365 days, or 240L of water usage if records are maintained, notes Keefer. “If an office is concerned about monitoring CFU counts, we recommend independent testing by an outside laboratory,” she says. “For offices that are concerned that the iodine level stays within the range provided in the DentaPure cartridge IFU, Crosstex offers iodine test strips.” Testing frequency – both for CFU counts and iodine levels – varies by practice, she adds.

Crosstex strongly recommends the following best practices in conjunction with use of its DentaPure cartridges and Liquid Ultra™ Solution:

  • Flushing for 20 to 30 seconds between patients.
  • Sterilizing all handpieces after each use.
  • Emptying independent water bottles nightly and setting them upside down to dry to avoid biofilm growth from untreated water remaining in the bottle.
  • Wiping down the outside of the cartridge with a clean paper towel before replacing the bottle.
  • Filling bottles with fresh water (tap or distilled) each morning before each use.

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


Waterborne opportunistic pathogens in DUWLs

While some organisms have been identified in dental unit water as a result of back-flow from patients (oral microorganisms) the majority of microbial species found in DUWL output water are Gram-negative aerobic (without oxygen) heterotrophic (live off of others/carbon loving) mesophilic (heat loving) environmental (waterborne) bacterial species. These opportunistic waterborne bacteria attached to the inner-surface of the tubing with an insoluble slime layer. As the microorganisms grow and multiply, they create a more complex and potentially pathogenic environment. Eventually pieces of the biofilm may break off and be carried through the dental tubing via the waterflow eventually delivered to the patient’s mouth.

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

Evacuation Line Maintenance

Waterline Treatment

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

Safe and economical
In recent years, more cleaners have become available that feature a neutral pH, making them compatible with the office’s amalgam separator. Natural ingredient-based products have also been introduced and will be further evaluated for use in the next several years.

Still, some dentists have been reluctant to use them, objecting to the time investment and the risk of spillage. There has also been some objection to the cost of the cleaner and the need to adjust to a new dosage when switching to a new product. However, cleaning suction lines daily for both dry and wet vacuum systems is necessary to remove and prevent debris build-up and ensure proper suction flow.

When cleaners are used appropriately, they provide a safe, economical solution. For instance, the use of a non-foaming cleaner generally is recommended for use with dry vacuums, as foam cleaners tend to leave the turbine coated with residue and debris, leading to lower performance, loss of suction and eventual pump failure.

Dental providers should be aware of CDC recommendations to keep suction lines disinfected daily in case backflow occurs when using a saliva ejector. For more information visit https://www.cdc.gov/oralhealth/infectioncontrol/faq/saliva.htm.

In addition, they can refer to the book Infection Control and Management of Hazardous Materials for the Dental Team, which states:

High-volume evacuation (HVE) during the use of rotary equipment and the air/water syringe greatly reduces the escape of salivary aerosols and spatter from the patient’s mouth, which reduces contamination of the dental team and nearby surfaces. One should clean the HVE system at the end of the day by evacuating a detergent or water-based-detergent disinfectant through the system. One should not use bleach (sodium hypochlorite) because this chemical can destroy metal parts in the system. One should remove and clean the trap in the system periodically. A safer approach, however, is to use a disposable trap. These traps may contain scrap amalgam and should be disposed of properly. The dental team member must wear gloves, masks, protective eyewear and protective clothing when cleaning or replacing these traps to avoid contact with patient materials in the lines from splashing and direct contact. Disinfection of the trap by evacuating some disinfectant-detergent down the line, followed by water, is best before one cleans or changes the trap.

Resource: Miller CH. Infection Control and Management of Hazardous Materials for the Dental Team, 5th edition. Elsevier/Mosby Publishers. Page 181.

Editor’s note: Sponsored by Air Techniques


Dental effluent guidelines

Mercury pollution is widespread and a global concern that originates from a number of sources, including dental offices. In fact, dental clinics are considered to be the main source of mercury discharges to publicly owned treatment works (POTWs), according to the Environmental Protection Agency (EPA). According to EPA estimates, approximately 103,000 dental offices use or remove amalgam in the United States, and almost all of these send their wastewater to POTWs. Furthermore, dentists discharge approximately 5.1 tons of mercury each year to POTWs, most of which is subsequently released to the environment.

Mercury-containing amalgam wastes generally find their way into the environment when new fillings are placed or old mercury-containing fillings are drilled out and waste amalgam materials that are flushed into chair-side drains enter the wastewater stream. Mercury entering POTWs frequently partitions into the sludge – the solid material that remains after wastewater is treated. Mercury from waste amalgam therefore can make its way into the environment from the POTW through the incineration, landfilling or land application of sludge, or through surface water discharge.

Amalgam separators are regarded as a practical, affordable, available technology for capturing mercury and other metals, before they are discharged into sewers that drain to (POTWs). Once captured by a separator, mercury can be recycled.

In July 2017, the EPA passed its final rule specific to Best Management Practices for Dental Amalgam Waste, prohibiting the use of bleach or chlorine-containing cleaners that may lead to the dissolution of solid mercury when cleaning chair-side traps and vacuum lines. The rule says, “…vacuum lines that discharge amalgam process wastewater to a POTW [publicly owned treatment works] must not be cleaned with oxidizing or acidic cleaners, including but not limited to bleach, chlorine, iodine and peroxide that have a pH lower than 6 or greater than 8.” (40 CFR 441.30(b)(2)).

EPA expects compliance with this final rule will reduce the discharge of mercury by 5.1 tons each year, as well as 5.3 tons of other metals found in waste dental amalgam to POTWs. For more information visit the EPA website: https://www.epa.gov/eg/dental-effluent-guidelines.

Editor’s note: Sponsored by Air Techniques.

ADSO 2018 Annual Summit

Editor’s note: When dentists receive good administrative support services, they can focus on patients, expand access to quality dental care and improve the oral health of their communities. In this issue, the Association of Dental Support Organizations (ADSO) presents its 2018 Annual Summit.

CEOs Pat Bauer, of Heartland Dental

Steve Bilt, of Smile Brands, Inc

Kenneth Cooper,
of North American Dental Group

The Association of Dental Support Organizations (ADSO) has released the agenda for the 2018 ADSO Summit at the JW Marriott Austin in downtown Austin, Texas. The conference will begin the morning of April 17 and conclude Friday evening, April 20.

This year’s agenda is stacked with outstanding speakers who will cover a range of topics designed for every member of the team, with breakouts on topics such as leadership, marketing and public relations, human resources and recruitment, advocacy, and growth and development. DSOs and group practices of all sizes will benefit from the general sessions, breakout sessions, round table discussions, talk table visits with industry partners and networking receptions.

CEOs Pat Bauer, of Heartland Dental; Steve Bilt, of Smile Brands, Inc.; and Kenneth Cooper, of North American Dental Group, will lead a general session on Leading Change: Supporting and Developing Newly Acquired Practices, which will include information on best business practices, collaboration and learning opportunities.

The ADSO Summit draws C-level executives and team members from DSOs, as well as industry partner representatives from more than 150 companies. The full agenda for the annual meeting can be found at: http://theadso.org/wp-content/uploads/2018/01/ADSO_Summit_Program_2018_Print.pdf. For more information on the preeminent DSO event of the year, please visit www.theadso.org. If your organization is not currently a member, email us at membership@theadso.org to join and receive complimentary registrations for

Publisher’s Letter

Clinical Advances

Bill Neumann

As I write this publisher’s letter, I am on an airplane headed to the 153rd Chicago Midwinter meeting. The Chicago Midwinter is one of the largest dental shows in the United States. Equally important, the Midwinter meeting is typically viewed as a new product launch meeting. Dental manufacturers, distributors and technology companies will have their latest and greatest products and services on display for dental practices both large and small.

I speak to many clinical directors and procurement managers of both emerging groups and larger more established dental support organizations who attend this meeting, as well as other dental trade shows. Many attend in order to schedule meetings with their vendor partners, and to experience the latest clinical advances that their group may want to adopt.

If the Chicago Midwinter meeting was not on your travel itinerary for 2018, don’t worry because we asked key influencers in the dental group space their thoughts on 2018’s clinical advances. In this issue of Efficiency in Group Practice we highlight several clinical advances to watch, and get input and perspective from both DSOs and their manufacturer partners. It is important to understand that one of the key drivers of faster adoption by dental groups of these clinical advances and technologies are the realities that today’s patients are better educated, do more research online, and expect better service and outcomes.

David Vieth, DDS, Chief Dental Officer of Kool Smiles talks about newer technologies such as 3D Imaging/ CBCT and digital radiography. Dr. Vieth points out that not only are patients more educated and expect these technologies, but not having these types of clinical advances in a DSO can hinder recruitment and retention of dentists and other clinical staff. Dr. Robert Brody, Chief Clinical Officer of Great Expressions Dental Centers addresses advancements in dental materials, refinements with intra-oral scanners, and practice management scalability.

DSO Industry Partners, Ivoclar Vivadent and VOCO weigh in on how they and others continue the advancement of dental materials and technology and what that means to dental groups and their patients. Russ Perlman, Executive Director of Marketing & Communications at VOCO America hits on the common theme of highly educated patients and their equally high expectations. Focusing on advancements with universal adhesives, Perlman talks about the ability of dental groups to reduce adhesive inventories while increasing consistency and predictable results.

Whether you made it to Chicago Midwinter or not, there are some can’t miss clinical advances and more content in this issue of Efficiency in Group Practice.

Clinically yours,

Bill Neumann