November/December 19


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Moving Forward
As doctors grow in their profession, so must dental assistants. DSOs provide the opportunities they need

  • Assisting the Assistant
    When hygienists and dental assistants can work more efficiently, dentists and patients benefit.

Editor’s Note
Dental assistants? More like dental leaders.

ADSO Summit 2020

Dentists of Brighton, Pacific Dental Services
Millennial owner and Generation X associate bring customization to patient-centric practice

Efficient Protection
VistaCool™ Direct-to-Drain Cooling System for Autoclave Wastewater saves staff time while protecting cabinetry and drains from steam-sterilizer exhaust.

Be The First To Read Zyris’ Exclusive New e-Book!

The Dental Assistant
With advances in technology, dental assistants must be prepared to play an instrumental role in the practice

Dental Zirconia and Keys for Clinical Success

A Good Impression
Conventional impression materials continue to prove their value

Braced for Best Outcomes
Amid growing options for orthodontic treatment, orthodontists continue to offer patients their unique expertise.

Blue Light: An ocular risk
Safety protocols must keep pace with advances in dental materials and techniques

OSAP Dental Infection Control Boot Camp™

Organic Organizational Effectiveness
Three leadership imperatives from The Biggest Little Farm

Teledentistry: Key to engaging patients
When patients can’t come to the office, Paul Labbe, DDS, brings the office to his patients

News

Be The First To Read Zyris’ Exclusive New e-Book!

Sponsored Zyris

For nearly 20 years, Zyris has been helping clinicians to achieve a high standard of care through its highly-effective, technologically-advanced, award-winning solutions for minimally invasive, easy-to-use dental isolation — as well as control of the oral environment.

Zyris’ new Isolite 3 dental isolation system provides unparalleled visibility, better oral humidity control, and minimizes the chance of accidental contamination. The system’s patented design allows dentists to quickly and easily implement a standard protocol for consistent outcomes in procedures that benefit from and require moisture control and isolation.

Zyris’ new eBook, published in partnership with Share Moving Media, drills down into how the Isolite 3 system can improve each aspect of the dental practice.

The first chapter addresses the clinical benefits that will be realized by dentists switching to the Isolite 3. Namely, the chapter covers how the Isolite 3 will help clinicians to elevate the quality of their work while also being able to complete dental procedures up to 30% faster than using traditional methods of isolation. The chapter also discusses how the system’s Liquidmetal® construction makes the device sturdier and more ergonomic, as well as how the Isolite 3’s brighter illumination and new amber light can provide a superior lighting experience.

The second chapter reveals how the Isolite 3 can help hygienists to achieve superior results for dental procedures that require isolation. The chapter covers how the Isolite 3 system helps to reduce neck and back pain for users as well as reducing chair time per patient. Better isolation means better, faster, safer and more comfortable procedures – for both clinicians and patients. Importantly, this chapter deals with the challenges of traditional 4-hand dentistry, and how the Isolite system helps to overcome those challenges so that the hygienist can always stay one step ahead of the dentist.

The final chapter of Zyris’ eBook is a thorough look at the value-prospect of the Isolite 3 system. This chapter, aimed at those who work in the dental practice’s “back office” shines a light on how the features of the Isolite 3 device can help dentists achieve superior results while reducing chair times and increasing patient comfort. It also takes a look at the various financial benefits to the dental practice – from the company’s 30-day trail to its outstanding warranty program.

Dental practices of all sizes can benefit from the new Isolite 3 system. To access the eBook, www.zyris.com/smm.

Efficient Protection

Sponsored Crosstex

VistaCool™ Direct-to-Drain Cooling System for Autoclave Wastewater saves staff time while protecting cabinetry and drains from steam-sterilizer exhaust.

Adhering to proper sterilization protocols in the dental practice is key to infection control and the safety of patients and staff. But sterilization comes with its share of challenges. For instance, with steam sterilization, autoclaves that use fresh water for each cycle must exhaust wastewater in the form of steam and condensation. Most sterilizers discharge this steaming-hot exhaust into some form of condenser bottle, which is typically located beneath the sterilizer inside a base cabinet. It’s important that this sterilizer wastewater is managed properly, but dealing with it can be problematic.

Over the course of multiple sterilization cycles, these condenser bottles fill up and can get very hot. It’s not unusual for busy practices to have to empty the bottles many times throughout the week, creating additional tasks for office staff members. If the bottles are emptied too soon, before they have sufficiently cooled, the wastewater can actually melt plastic plumbing. On the other hand, if the bottles aren’t emptied frequently enough, they can overflow inside the cabinet. In addition, spills and steam that escape from condenser bottles create a humid environment, which can contribute to delamination, mildew, rot and rust inside sterilization center cabinets.

To help dental practices protect drains and cabinets, as well enhance office efficiency, Crosstex, a Cantel Medical Company, now offers the VistaCool™ Direct-to-Drain Cooling System for Autoclave Wastewater. This patent-pending system saves staff time by eliminating the need for office staff to empty condenser bottles manually. And because it’s non-electric and self-regulating, there’s no user maintenance required. Unlike other systems, only the VistaCool™ Direct-to-Drain Cooling System for Autoclave Wastewater can refresh its own coolant water when it senses that the water in the tank has become too warm to serve as an effective coolant.

Not only does the system prevent sterilizer wastewater from melting plumbing, the CSA-certified backflow prevention meets or exceeds most local plumbing codes. And because cooled wastewater is sent directly down the drain, dental professionals can rest assured their cabinets will be protected from potential damage due to spills or the humid environments created by exhaust from condenser bottles.

Consider this!
Few dental professionals would question the importance of sterilization. But the sterilization process inevitably raises several questions, such as:

  • How will the steam sterilizer exhaust be collected and managed?
  • Will our staff have to monitor and manually empty the sterilizer wastewater multiple times each week? If so, how much time will this take, and how safe is it for them to handle bottles of hot condensation?
  • What are the odds of a condenser bottle overflowing if the staff becomes busy and forgets to empty it?
  • Could our dental cabinets become warped, delaminated or otherwise damaged as a result of steam from condenser bottles?

The VistaCool™ Direct-to-Drain Cooling System for Autoclave Wastewater is approved for use with some of the leading fresh-water sterilizers on the market, including both newer and older SciCan STATIM 2000 and 5000 units, as well as the Midmark and Ritter M3. For practices that prefer using fresh water instead of recirculated water for sterilization, the double-sterilizer model of the VistaCool™ Direct-to-Drain Cooling System for Autoclave Wastewater enables Midmark and Ritter M9 and M11 UltraClave Automatic Sterilizers to use fresh water for each cycle by sending wastewater directly to the drain. This modification requires the use of a simple, Midmark-approved adapter kit.

Learn more at Crosstex.com/VistaCool.

Editor’s note: Sponsored by Crosstex International Inc, a Cantel Medical Company.

Dental Zirconia and  Keys for Clinical Success

Sponsored Ivoclar Vivadent

By Shashikant Singhal, B.D.S., M.S.,  director of professional services, Ivoclar Vivadent, Inc.

Figure 1

Dentists have increasingly requested zirconia as an alternative to porcelain-fused-to-metal (PFM) restorations and more recently to glass ceramic restorations as well. For more than 15 years, zirconia has been used for fabricating restoration frameworks based on the material’s versatility in mechanical and physical properties, which has allowed clinicians and laboratory technicians to use it for various clinical indications. The first zirconia restorative materials on the dental market were 3Y-TZP powders. Although these materials had high mechanical properties, they were dense and opaque, falling short of meeting dentists’ requirements for esthetics, which were equally important to strength considerations. Since then, the number and compositions on dental zirconia materials have grown rapidly.

With recent advancements, a variety of zirconia materials (4Y-TZP, 5Y-TZP) has become available to meet dentists’ different functional and esthetic demands. Differentiated by a number of factors – including composition, mechanical and optical properties – today’s new zirconia materials offer dentists and laboratories solutions that can be milled to full contour, and that demonstrate acceptable esthetics and translucency suitable for clinical situations where high mechanical stability, thin restoration walls and natural esthetics are essential.

Figure 4

What is dental zirconia?
Dental zirconia (ZrO2) is the oxide version of zirconium (Zr). Zirconium occurs in nature only as a mineral – mostly as zircon (ZrSiO4) – and is a soft, ductile, shiny-silvery metal, optically similar to aluminum foil.1,3 To produce dental zirconia, zircon is purified via complex production and purification processes and converted into synthetic zirconium precursors, which are finally transformed into ZrO2 through thermal and mechanical processes. These are the only synthetic powder components used to make dental zirconia.1-3

Zirconia is polymorphic ceramic; depending on temperature and pressure, the same elements of the material exist in three different crystal structures (i.e., monoclinic (m); tetragonal (t); and cubic (c)). Pure monoclinic zirconia, the most stable phase, is present at room temperature. At about 1170°C, the monoclinic phase transforms into the tetragonal phase, with an approximately 4-5 percent volume shrinkage. At about 2370°C, the tetragonal phase then converts into the cubic phase. These transformations occur within a temperature range (rather than at a specific temperature) and involve movement of atoms within the crystal structure.

The tetragonal and cubic phases of zirconia can be made stable at room temperature by incorporating additional components (dopants), such as yttrium oxide (Y2O3), calcium oxide (CaO) or magnesium oxide (MgO) into the ZrO2 crystal structure to form partially or fully stabilized zirconia.1-3

Figure 2

Without the addition of these components, tetragonal converts back into a monoclinic below 950°C and, hence, cannot be used clinically. (Figure 2). Low amounts of these dopants lead to partially stabilized zirconia, with mainly metastable tetragonal and cubic phases.1-3 For example, how much dopant in molar concentration is used in a zirconia is abbreviated as 3Y-TZP for 3 mol percent Y2O3; 4Y-TZP as 4 mol percent Y2O3; or 5Y-TZP as 5 mol percent Y2O3. When approximately 4.5-6 wt percent (3 mol percent or 3Y-TZP) yttria is added to a structure, a 100 percent tetragonal phase (traditional dental zirconia) can be produced at room temperature. When approximately 9.0-10.0 wt percent (5 mol percent or 5Y TZP) yttria is added, a structure of 50 percent tetragonal/50 percent cubic phase (known as cubic or HT zirconia) can be produced at room temperature. When these powders are mixed, an approximately 6.5-8.0 wt percent yttria containing zirconia can be produced (4 mol percent or 4Y TZP) giving a microstructure of 75 percent tetragonal and 25% cubic (Table 1).

The composition of zirconia material defines its mechanical and physical properties and hence clinical indications. The biaxial flexural strength of zirconia materials ranges from 650 MPa (5Y-TZP) to 1,200 MPa (3Y-TZPP). The higher the value, the stronger the material. In addition, the presence of polymorphic phases in zirconia material provides a phenomenon known as phase transformation toughening. It causes the tetragonal crystals to change to monoclinic when a crack is introduced. The monoclinic phase has a greater volume. This stops the crack from traveling through the material, basically pinching the crack shut (Figure 2) and, hence, further increases resistance to fracture. No phase transformation toughening can be observed in 5Y-TZP materials. Lastly, the translucency of 3Y-TZP is comparatively lower than 4Y-TZP and 5Y-TZP (most translucent), resulting in a clinical decision-making tree for clinical indications and cementation procedures.

Ensuring clinical success with today’s different zirconia materials|
As discussed earlier, the obvious disadvantage of new higher translucency and more esthetic ZrO2 materials is a reduction in the mechanical properties (e.g., lower fracture toughness, lower strength). There is a growing interest in using zirconia for fabricating monolithic, full-contour restorations – particularly different generations that demonstrate new levels of optical and mechanical properties to meet dentists’ demands. The composition, mechanical properties, optical characteristics and processing of these new zirconias are different from previous generations of the high-strength material.4,5

Currently, newer generation cubic – 5Y-TZP (e.g., CubeX2) or hybrid – 4Y-TZP (e.g., IPS e.max® ZirCAD MT) zirconia materials are limited to single-unit restorations, or to three unit bridges. These zirconias exhibit improved translucency for esthetic full-contour (i.e., monolithic) restorations, but they demonstrate lower mechanical properties and a reduction in strength and fracture toughness compared to some other restorative materials.6,7 This may limit their use to certain indications, wall thicknesses and connector dimensions.

The 3Y-TZP zirconia materials (e.g., IPS e.max® ZirCAD LT) are indicated for single-unit restorations to multi-unit bridge frameworks with a maximum of two pontics. These materials demonstrate high-strength, excellent mechanical properties and a low risk of temperature degradation; however, they exhibit a slightly lower level of translucency8. The newest generation of zirconia restorative material (IPS e.max® ZirCAD PRIME) has been introduced with a unique gradient technology. This technology allows gradation of 3Y-TZP and 5Y-TZP material in one puck, ensuring the strength of 3Y-TZP and esthetics of 5Y-TZP.

Therefore, clinicians should follow tooth preparation guidelines specific to their selected zirconia restorative material. It is also critical for both clinicians and dental laboratory technicians to consider the differences in properties among zirconia materials when selecting the ideal zirconia for a specific clinical indication.

Figure 3

Preparation guidelines for 3Y-TPZ zirconia materials range from 1.0 mm to 0.5 mm occlusal and axial reduction, whereas for 4Y-TZP and 5Y-TZP zirconia restorative materials, they range from 1.5 mm to 1.0 mm reduction (Figure 3). Additionally, the connector dimensions for bridges vary from 12.0 mm2 for 5Y-TZP and 4Y-TZP materials, compared to 7.0 mm to 9.0 mm2 for 3Y-TPZ zirconia materials.

Further, although there are various cementation options available for use with zirconia restorations (e.g., conventional, self-adhesive and adhesive cements), it is important to remember that the actual technique – and diligently following its protocol – also influences clinical restorative success. Clinicians often use conventional cements (e.g., resin modified glass inomers or glass inomers) when placing zirconia restorations, due to their ease of use. However, the limited bonding properties of conventional cements restrict their use in non-retentive tooth preparations.

The common myth is that zirconia material cannot be chemically bonded. However, it is well cited in the literature that zirconia restorations can be adhesively cemented if proper steps are followed. To ensure successful cementation, the following critical protocol should be implemented with zirconia restorations. Avoiding any step in the cementation protocol will compromise the clinical outcome.

  1. Zirconia restorations cannot be chemically etched. Traditional dental etching procedures are preferential and involve etching away the open glass phase structure in glass-ceramic restoration, like IPS e.max® lithium disilicate; this leaves the crystals, since zirconia has no secondary glass phase. Therefore, sandblasting the intaglio surface of a zirconia restoration using Al2O3 particles (50 µm) at 1 bar pressure – which is usually performed by the dental laboratory – roughens the zirconia surface to increase micro-retention for improved bonding.
  2. Figure 5

    After a try-in of the zirconia restoration in the patient’s mouth, it should be cleaned. Zirconia surfaces show a high affinity for phosphate groups, and saliva and other body fluids contain various forms of phosphate (e.g., phospholipids) that may react irreversibly with the restorative surface and compromise bonding. This also contraindicates the use of phosphoric acid on zirconia restorations. To clean zirconia restorative surfaces after try-in and create an optimum surface for adhesive bonding compared to other cleaning protocols, a unique product (Ivoclean®, Ivoclar Vivadent, Inc.) is indicated9, 10 (Figure 5).

  3. The cementation of zirconia restoration can be performed using an adhesive cement (e.g. Variolink® Esthetic, Multilink® Automix) or a self-adhesive cement (e.g., SpeedCEM® Plus). The cementation protocol includes application of primer on the restoration, followed by the use of cement. Unlike glass-ceramic bonding, which uses silane bonding, zirconia bonding uses phosphate end groups to bond. The use of primers containing phosphate end groups, or cements containing MDP (10-methacryloyloxydecyl dihydrogen phosphate), is recommended for achieving the best bonds to the tooth structure. The MDP-containing ceramic primers (e.g. Monobond Plus) should be applied on the restoration followed by extrusion of adhesive resin cement in the restoration. Because few self-adhesive resin cements (e.g., SpeedCEM® Plus) contain MDP, the application of restorative primer as a separate step can be eliminated. Finally, cement is extruded in the restoration; the doctor should seat it per path of insertion, followed by polymerization of the cement per the manufacturer’s recommendation. Lastly, the translucency of the zirconia restorations depends on the material’s composition and thickness, and hence light attenuation through the restoration varies. Therefore, it is critical to consider these factors while selecting the cement options. For opaque restoration, use of self-cure and dual-cure cements are recommended, and it is extremely important to let the cement set on a self-cure mode before checking occlusion or making occlusal adjustments.

References

  1. Volpato Maziero CA, D’Altoe Garbelotto LG, Celso Fredel M, Bondioli F. Application of zirconia in dentistry: biological, mechanical and optical considerations. Advances in Ceramics-Electric and Magnetic Ceramics, Bioceramics, Ceramics and Environment. 2011:397-421.
  2. Chen YW, Moussi J, Drury JL, Wataha JC. Zirconia in biomedical applications. Expert Rev Med Devices. 2016 Oct;13(10):945-963.
  3. Nielsen RH, Wilfing G. Ullmann. Zirconium and zirconium compounds. Ullmann’s Encyclopedia of Industrial Chemistry. 2010.
  4. Miyazaki T, Nakamura T, Matsumura H, Ban S, Kobayashi T. Current status of zirconia restoration. J Prosthodont Res. 2013 Oct;57(4):236-61.
  5. Ramos CM, Cesar PF, Bonafante EA, et al. Fractographic principles applied to Y-TZP mechanical behavior analysis. J Mech Behav Biomed Mater. 2016 Apr;57:215-23.
  6. Munoz EM, Longhini D, Antonio SG, Adabo GL. The effects of mechanical and hydrothermal aging on microstructure and biaxial flexural strength of an anterior and a posterior monolithic zirconia. J Dent. 2017 Aug;63:94-102.
  7. Zhang F, Inokoshi M, Batuk M, et al. Strength, toughness and aging stability of highly-translucent Y-TZP ceramics for dental restorations. Dent Mater. 2016 Dec; 32(12):e327-e337.
  8. Pinto PA, Colas G, Filleter T, DeSouza GM. Surface and mechanical characterization of dental yttria-stabilized tetragonal zirconia polycrystals (3Y-TZP) after different aging processes. Microsc Microanal. 2016 Dec;22(6):1179-88.
  9. Kim DH, Son JS, Jeong SH, Kim YK, Kim KH, Kwon TY. Efficacy of various cleaning solutions on saliva-contaminated zirconia for improved resin bonding. J Adv Prosthodont. 2015 Apr;7(2):85-92.
  10. Pathak K, Singhal S, Antonson SA, Antonson DE. Effect of cleaning protocols of saliva-contaminated zirconia-restorations: shear bond strength. J Dent Res. 2015;94 (Spec Iss A):3656.
Table 1 – Dental Zirconia Classification
3Y-TZP Zirconia 4Y-TZP Zirconia 5Y-TZP Zirconia
4.5 – 6.0 wt percent Y2O3 6.0 – 8.0 wt percent Y2O3 9.05 – 10.0 wt percent Y2O3
~100 percent Tetragonal phase ~75 percent Tetragonal phase ~50 percent Tetragonal phase
0 percent Cubic phase ~25 percent Cubic phase ~50 percent Cubic phase
HIGHEST Mechanical Properties
(~1,200 MPa)
HIGH Mechanical Properties
(~850 MPa)
LOWEST Mechanical Properties
(~650 MPa)
LOWEST Translucency  HIGHER Translucency  HIGHEST Translucency
Tetragonal phase helps with fracture toughness and strength while the Cubic phase helps with translucency

Teledentistry: Key to engaging patients

Sponsored MouthWatch

When patients can’t come to the office, Paul Labbe, DDS, brings the office to his patients

Dr. Paul Labbe

From the start of his career, Paul Labbe, DDS, owner of Texas-based Planet Dental, has made it a point to give back to the community. With four offices and a quality team of dental professionals strategically located in an underserved area of Southern Texas, it would appear he’s in a position to provide some deeply needed care. As he discovered, however, patients in need can be difficult to reach – that is, until he added teledentistry to his practice.

“The best part about this profession is the ability to give back to any community,” says Dr. Labbe. “In dental school, I had the opportunity to participate in several outreach programs, including a mission trip to Fiji, where we set up a clinic in a remote village and provided oral hygiene services, oral surgery, limited removable prosthodontics, direct glass isomer restorations and limited root canal services. I also was involved in a program that delivered dental care to the homeless in San Francisco.”

When he established his practice in the Laredo, Texas, area, for the most part he focused on treating underserved children. “Unfortunately, the parents of these children would habitually break dental appointments and usually only visited our office when their children’s caries were visible and at a rampant state,” he says. It was then he became aware of TeleDent™, a turnkey teledentistry platform by MouthWatch. “By utilizing TeleDent in our offices, we have been able to develop a screening program that includes local health fairs and school outreach events, making it possible to perform dental screenings in schools without using radiation to assess caries risk, identify decay and abscesses, or determine hygiene classifications.

Bringing awareness to the community
Dr. Labbe’s screening program, which is integrated with several local schools, is bringing awareness to parents and their children who otherwise might not visit a dentist, he notes. “This absolutely has had a positive effect on the community,” he says. “In fact, without teledentistry, it would be nearly impossible to reach these patients. “

“Before we had teledentistry, unless patients were in our office, we could not provide any caries risk assessment or recommendations,” says Dr. Labbe. “Today, with the help of a laptop, the TeleDent app, a MouthWatch intraoral camera, gloves and mirrors, we can screen for visible caries, infections, calculus and plaque buildup, eruption anomalies, mal occlusions and more. Essentially, we are able to take the diagnostic portion of the exam (excluding radiographs) outside of the office, and educate children and adults about their oral health.” Now Dr. Labbe and his team can share images with patients and their parents, which help them explain the diagnosis and recommendation. “As a result, our patients and their parents are much more engaged in their appointments and more willing to comply with treatment recommendations!”

A Good Impression

Conventional impression materials continue to prove their value.

There’s no denying dental technology has rapidly digitized in recent years. Still, many traditional technologies, such as conventional impressions, continue to play an important role in patient healthcare. Conventional impressions are still required for subgingival tooth preparations. In addition, impression materials can displace blood and saliva, whereas digital impression systems are not able to capture the margin when moisture or soft tissue blocks the tooth preparation. From gingival retraction pastes to compact intraoral syringes for efficient application of wash material, the technology behind conventional impressions is continually improving.

From general dentists to orthodontists, prosthodontists and oral surgeons, dental professionals continue to rely on conventional impressions to create custom restorations, such as crowns, bridges and implants, as well as orthodontic appliances.

SA history of precision
Since reversible hydrocolloids were developed in the 1930s, enabling dentists to make impressions of undercuts, precision impression materials have become increasingly versatile. Soon after, dentists began using polysulfides and C-type silicones, although these materials were associated with shrinkage.

By 1965, ESPE – currently 3M Oral Care – had introduced polyether impression material as a single-step, medium viscosity impression material. Considered unique for its time, polyether impression material was known for its highly mechanical properties and excellent elastic recovery. And, there was virtually no concern about shrinkage. Dentists could depend on the material’s intrinsic hydrophilicity, and unique flow and setting behavior.

Polyether materials have been the go-to material for challenging cases. Their long working time and excellent flowability has facilitated precision and accuracy in implants and large restorations. Today’s polyether impression materials include viscosities, from heavy-body tray materials to light-body materials, enabling them to be used for a full range of indications.

Soon after the invention of polyether impression materials, new silicone chemistries were introduced, which were formulated with improved hydrophilicity. Vinyl polysiloxanes (including VPS/PVS, additional silicones and A-silicones) have always been intrinsically hydrophobic, but the addition of a surfactant has improved hydrophilicity. Recent vinyl polysiloxanes are known to contain tailor-made cross linkers designed for high tensile strength, resulting in high tear resistance and high elastic recovery. These materials are commonly used with popular double-bite and one-step techniques. By selecting the proper working and setting time of a material, a full range of crown and bridge indications can be accomplished.

Alginates
Developed in the late 1930s, soon after reversible hydrocolloids, alginates continue to be used for preliminary impressions. They generally are mixed by hand, since their material properties are only slightly improved with mixing devices. However, alginates provide poor surface detail reproduction and impressions must be cast within 15 to 30 minutes, since the impression shrinks as water evaporates from the alginate gel. This makes alginate impressions poorly suited for the preparation of temporary restorations, since they cannot be stored and reused. That said, alginates have low tear resistance, which can sometimes be an advantage, as when taking an impression of a periodontally affected tooth or over-fixed orthodontic appliances. These cannot be reproduced with tear-resistant materials, since that material cannot be removed from the patient’s mouth.

As an alternative, alginate replacements were introduced as cost-effective VPS materials offering high-dimensional stability. Alginate replacements are used to fabricate temporary restorations, as their smooth silicone surface can be easily trimmed. And because the impression has an unlimited shelf life, it can be used to remake temporary restorations when needed. These materials can be automatically mixed with hand dispensers or automatic mixing systems, eliminating mixing and processing errors.

Hand-mixed vs. automatic
All impression materials must be mixed from at least two components – usually a base and catalyst paste. Most impressions are still performed with hand-mixed materials, although hand dispensers with dual-barrel cartridges have been available since 1983 and automatic mixing systems for foil bags since 1993.

Ergonomic and clinical considerations often prompt dental practices to upgrade to automatic mixing systems. These systems enable dental professionals to fill the impression tray with the touch of a button, saving time and reducing stress. In some cases, a dental practice will upgrade after experiencing problems with an inadequate mix or to reduce material costs associated with hand dispensers.

Is it time to make a change?
Dentists might ask themselves if their current impression material has merely been doing the job. If so, there may be a solution better suited to the needs of their practice. Some points to consider include:

  • What do I like/dislike about my current impression material? Is there something I would like to change?
  • What percentage of impression retakes are necessary using my current impression material?
  • How long do my impression appointments generally take?
  • Would upgrading to an automatic mixing system help increase office efficiency at my practice?

Over time, impression materials have proven their value, and they likely will continue to do so for years to come. Equipped with the right solutions, dentists and their assistants are more likely to achieve the best possible results.

Editor’s note: Efficiency in Group Practice would like to thank 3M for its assistance with this article.

Blue Light: An ocular risk

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

By Dr. Katherine Schrubbe, RDH, BS, MEd, PhD.

Safety protocols must keep pace with advances in dental materials and techniques

In the hustle and bustle of today’s busy dental practices, safety must remain a priority.  Compliance to Occupational Safety and Health Administration (OSHA) standards and Centers for Disease Control and Prevention (CDC) recommendations form the foundation and best practices of procedures and protocols that drive this safety. Dentistry is a science that requires not only precision hand skills, but also accurate vision; thus, eye protection from all hazards is critical for a long, successful career of caring for patients.

Most providers are keenly aware of the risks of ocular injury and exposure from spray and spatter of patient oral fluids. The OSHA Bloodborne Pathogens Standard states, “when splashes, sprays, splatters or droplets of blood or OPIM pose a hazard to the eyes, nose or mouth, then masks in conjunction with eye protection (such as goggles or glasses with solid side shields) or chin-length face shields must be worn.”1  The CDC concurs, stating, “dental health care personnel should wear protective eyewear with solid side shields or a face shield during procedures likely to generate splashes or sprays of blood of body fluids or the spatter of debris.”2

A new ocular risk
With advances in restorative dentistry and the trend of placing composite restorations rather than amalgam, there is a new ocular risk providers must pay attention to: blue light.3 Light curing units (LCUs) are not only used for curing composite restorations, but also for bonding and tooth whitening, and the lights have become more intensified over time. Most adhesive materials found on the market today contain photoinitiators, material components that require absorption of optical radiation in the wavelength range ∼350-500nm to set. Light emitting diode (LED)-based curing lights are the most used light sources with an emission peak in the blue/blue-green range (430-490 nm).4

Quartz-tungsten-halogen (QTH) light curing units (LCUs) have dominated light curing of dental materials for decades and are now almost entirely replaced by modern LED LCUs.  Visible LEDs were invented in the early 1960s. Nevertheless, it was not until the 1990s that LEDs were seriously considered by scientists or manufacturers of commercial LCUs as light sources to photopolymerize dental composites and other dental materials.5  

So, how does blue light affect the eyes of dental team members who use it? Blue light has the shortest wavelengths of all types of visible light (380-495 nm). Accordingly, blue photons have greater energy than photons with longer wavelengths, and high-frequency blue light is sometimes referred to as high-energy visible light.6 Many studies have been done on ocular hazards of LCUs used in dentistry. A recent study by Alasiri et al was published this April, as a systematic review of online PubMed and Google Scholar databases. The objective of the study was to examine the literature and summarize studies that describe the potential ocular hazards posed by different systems of LCUs used in dental clinics to ensure the safety of the operator, patient and auxiliary staff. The results confirmed most of what is now widely known – that blue light radiation can cause moderate-to-severe retinal damage to both dental healthcare workers and patients who are exposed for long periods of time without wearing eye protection. Blue light has a higher energy and can penetrate to the back of the eye at the retina, which is susceptible to damage, risk of burning, enhanced retinal aging and, over time, macular degeneration.6,7,8

Graphic courtesy of Palmero Healthcare

Along with blue light exposure of LCUs, many practices – especially large groups and DSOs – use electronic patient record systems. The use of computers, phones and other devices with electronic displays are means of additional exposure of eyes to increased amounts of light stimulation. As phototoxicity contributes to the progression of retinitis pigmentosa and age-related macular degeneration, which are major causes of blindness worldwide, the influence of light on the retina is a public health concern.6

How much blue light from LCUs are dentists exposed to? While this differs based on each practice and provider, in a study of Norwegian dentists4, the researchers found they spent on average 57.5% of their working days placing restorations (ranging from 1 to 30 restorations per day). The average length of light curing for one normal layer of composite was 27 seconds. The longest individual mean curing time per day was approximately 100 times higher than that of the lowest. Almost one-third of the dentists used inadequate eye protection against blue light.4

Recommendations for eye safety to blue light
Orange- and/or bronze-colored filters block blue light most effectively. Orange filters cut out more blue light than bronze filters and block blue light wavelengths of anywhere between 385-495nm. Therefore, it is possible to greatly reduce the effects of blue light on the eyes by ensuring that it has to pass through filters, such as functional protective eyewear that contain these colors.6   Where there is not specific guidance related to a worker hazard, the employer can invoke OSHA’s General Duty Clause as a strategy to mandate additional safety measures for employees. The General Duty Clause states, “each employer shall furnish to each of its employees a workplace that is free from recognized hazards that are causing or likely to cause death or serious physical harm.”9  Thus, any recognized hazard not covered in a standard, such as the Bloodborne Pathogens, is covered under the General Duty Clause and the employer must implement a feasible and useful method to correct the hazard, such as standard protocols to wear and use special orange filter eyewear to protect dental healthcare team members from potential ocular injury of blue light exposure.

Graphics courtesy of Palmero Healthcare

Looking away from the light is not recommended; in many cases this behavior causes the curing light operator to move the light away from the restoration area, resulting in decreased light dose to the material, which may compromise restoration quality.4    Currently, the most important recommendations regarding the use of blue light in dentistry are to read the manufacturer instructions for curing devices and to use radiation-filtering protection goggles.6

Protecting clinicians’ eyes from blue light exposure of LCUs is just as important as protecting eyes from patient oral spray and spatter, but not as widely practiced or accepted. Team members must be informed and educated on the hazards of long-term exposure to blue light, and as specific safety eyewear is indicated to reduce the potential of ocular injury from patient oral fluids, blue light filtering eyewear should be utilized to protect the eyes of team members during procedures involving LCUs. Employers and management teams must ensure compliance and keep up with appropriate safety protocols as dental materials and techniques continue to advance.

References

  1. U.S. Department of Labor. Occupational Safety and Health Administration; Bloodborne Pathogens Standard. Available at  https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS. Accessed September 17, 2019.
  2. U.S. Centers for Disease Control and Prevention. Oral Health; Personal Protective Equipment.Available at https://www.cdc.gov/oralhealth/infectioncontrol/faqs/personal-protective-equipment.html. Accessed September 17, 2019.
  3. Eklund, SA. (2010). Trends in dental treatment, 1992 to 2007. J. Am. Dent. Assoc., 141(4): 391-399.
  4. Kopperud,SE., Rukke,HV., Kopperud,HM., Bruzell,E.M. (2017). Light curing procedures – performance, knowledge level and safety awareness among dentists. Journal of Dentistry, 58: 67-73.
  5. Jandt, KD., Mills, RW. (2013). A brief history of LED photopolymerization. Dental Materials,29 (6): 605-617.
  6. Yoshino, F., Yoshida, A. (2018). Effects of blue-light irradiation during dental treatment. Japanese Dent Sci Rev, 54 (4):160-168.
  7. Alasiri, RA., Algarni, HA., Alasiri, Reem A. (2019). Ocular hazards of curing light units used in dental practice – A systematic review. Saudi Dent J, 31(2):173–180.
  8. Ham, WT, Jr., Ruffalo, JJ, Jr., Mueller, HA., Clark, AM., Moon, ME. (1978). Histologic analysis of photochemical lesions produced in rhesus retina by short-wave-length light. Investigative Ophthalmology and Visual Science, 17(10):1029-1035.
  9. U.S. Department of Labor. Occupational Safety and Health Administration. General Duty Clause. Available at https://www.osha.gov/laws-regs/oshact/section5-duties. Accessed September 17, 2019. 

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

OSAP Dental Infection Control Boot Camp™

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™ – will host the OSAP Dental Infection Control Boot Camp™ in Chicago at the Chicago Marriott Downtown Magnificent Mile, Jan. 27-29, 2020. OSAP Dental Infection Control Boot Camp™ is a three-day, fast-paced educational course presented by national and international experts in dental infection prevention and patient safety. The course will provide a comprehensive review of all the basics in dental infection control, as well as offer 25-plus hours of CE credit plus a copy of the newly updated OSHA & CDC Guidelines: OSAP Interact Training System – a 6th Edition workbook with checklists, tools and more.

The course is designed for:

  • Infection control coordinators in busy dental practices.
  • Educators responsible for infection prevention and safety instruction.
  • 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 responsible for infection control.
  • Consultants and sales representatives who want to demonstrate infection control competency.

Upon completion of this course, participants will be able to:

  • Describe disease transmission and principles of infection prevention and control in a variety of oral health care settings.
  • Identify relevant infection control laws, regulations, guidelines, standards and best practices.
  • Use quality assurance measures (e.g., direct observation and feedback) to ensure accurate implementation of recommended infection control practices.

Not only will participants leave the 2020 OSAP Dental Infection Control Boot Camp™ with new information, resources and products to help them better address infection prevention and safety challenges, they will meet new colleagues who share their interest in this critically important topic area.

On Jan. 26, 2020, from 2-5 p.m., Boot Camp will kick off with the TeamSTEPPS Pre-conference Workshop. A product of more than 25 years of experience with the Agency for Healthcare Research and Quality and the TeamSTEPPS curriculum, the workshop is designed to help break down communication barriers between healthcare professions.

The OSAP Dental Infection Control Boot Camp™ will follow the workshop and run:

  • Jan. 27, 7:30 a.m. – 4:30 p.m.
  • Jan. 28, 7:30 a.m. – 5:30 p.m.
  • Jan. 29, 7:30 a.m. – 4:15 p.m.

Information on the faculty, agenda and other details regarding the educational program will be posted at www.osap.org.

The U.S. Army, Navy and Air Force each will have additional training sessions on Jan. 30. Ranking officers will be required to attend and civilians employed by these branches will be encouraged to attend as well. (Federal service dress codes are posted at www.osap.org).

Dental assistant scholarship
OSAP is excited to present dental assistants attending the 2020 Boot Camp a scholarship in memory of Anna Nelson, CDA, RDA, MA. Qualified applicants will receive:

  • 25% off the early-bird member rate for 2020 OSAP Dental Infection Control Boot Camp™ ($106.25 value).
  • One free year of the OSAP Basic Membership (an online membership with a $75 value).

Dental assistants are encouraged to apply for this scholarship prior to registering. Scholarships are limited to 30 and will be awarded on a first-come, first-serve basis, provided the eligibility requirements are met.

Registration
OSAP member registration fees apply to all membership levels, except for those with the Basic Membership (online membership). Registrants must log into their OSAP account to receive the member rate.

2020 Dental Infection Control Boot Camp™
Jan. 27-30, 2020 – Chicago
Registration
Registration Fees Early-Bird Pricing by 10/31/2019 Received After 10/31/2019 Received After 12/15/2019
OSAP Members and Military/Federal Service Personnel $425 $505 $665
Non-members $625 $705 $865
Additional Attendees from Same Facility $325 $405 $565
TeamSTEPPS Pre-Conference
Jan. 26, 2020 – Chicago
Registration
Registration Fees Early-Bird Pricing by 10/31/2019 Received After 10/31/2019 Received After 12/15/2019
OSAP Members and Military/Federal Service Personnel $75 $100 $150
Non-members $105 $130 $180

To ensure we can accommodate your needs, please indicate your requirements on the registration form. If you have any questions, contact OSAP at office@OSAP.org.

The OSAP Dental Infection Control Boot Camp™ is the only course in the country that focuses solely on developing leaders in this critical topic. Potential exhibitors and sponsors who sell infection control or patient safety products will not want to miss it!

Additional registration information is coming soon and will be available at www.osap.org.

Questions about the program, logistics or registration should be directed to:

Email: office@OSAP.org
Phone: 410-571-0003 | U.S. and Canada: 1-800-298-6727
Mailing Address:  3525 Piedmont Rd. | Building 5, Ste. 300 | Atlanta, GA 30305

Continuing dental education
OSAP is an ADA Continuing Education Recognition Program (CERP) Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Participants requesting professional CE credits will receive a CE verification form to record the CE numbers for the specific courses they attend. To receive CE credit, participants must sign in at the conference, attend the sessions, record the assigned CE number for each lecture attended (note: CE verification numbers are announced at the end of each session) and complete the required evaluation forms. Attendees will need to maintain their CE verification form as proof of participation in the educational programming.

Cancellations and refunds
All registration cancellations and refund requests must be made in writing by Dec. 15. An 80% refund of conference fees will be given for cancellations received by Oct. 31. A 50% refund of conference fees will be given for cancellations received between Nov. 1 and Dec. 15. No refunds will be granted for requests postmarked after Dec. 15. Requests should be submitted to OSAP via email at office@osap.org. OSAP regrets that refunds will not be given for no shows. All requests for exceptions to the cancellation and refund policy must be submitted in writing by the registrant with appropriate documentation no later than Dec. 15. After that, no refund considerations will be made.

Substitutions within this program will be accepted. Individuals may receive a substitution for a full registration prior to the conference by submitting a written request to office@osap.org. Onsite transfers will not be permitted. The individual submitting the substitution request is responsible for all financial obligations (any balance due) associated with that substitution before the change can be made. Badge sharing, splitting and reprints will be strictly prohibited.

OSAP is not responsible for airfare, hotel or other costs incurred by participants in the event of a program or registration cancellation. As added protection against unforeseen circumstances, OSAP suggests travel insurance.

OSAP will offer registrants contact information to facilitate networking after the course. By registering, individuals give OSAP permission to include their name and contact details on the attendance list. During the registration process, there is an option to opt-out of this attendance list. Alternatively, individuals who do not wish to be included on the attendance list should email their exclusion request to office@osap.org by Dec. 15.

OSAP takes photos during the course. By registering, participants give OSAP permission to use any images taken at the course in which they appear, as well as any written comments they submit on evaluation forms.

Code of conduct
OSAP’s Code of Conduct outlines OSAP’s expectations for anyone attending or contributing to an OSAP meeting or educational activity, as well as the consequences for unacceptable behavior. If any participants are the subject of unacceptable behavior or witness any such behavior during conference events, they should contact Michelle Lee, OSAP’s Executive Director at 404-944-4824 or mlee@osap.org.


Editor’s note: OSAP focuses on strategies to improve compliance with safe practices and on building a strong network of recognized infection control experts. The organization offers an online collection of resources, publications, FAQs, checklists and toolkits that help dental professionals deliver the Safest Dental Visit 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 www.osap.org.

Braced for Best Outcomes

By Laura Thill

Amid growing options for orthodontic treatment, orthodontists continue to offer patients their unique expertise.

A beautiful smile can do wonders for our self-esteem, particularly when our photo is plastered across Facebook and Instagram. And patients today have more options for improving their smile than ever before – from ordering aligners online to seeking treatment from a general dentist. That said, some dental professionals believe there are advantages to working with an orthodontist.

For one, orthodontists bring additional training – usually between two and three years of specialized academic and clinical training – to the operatory, compared to general dentists. “This equips the specialist to treat a wide range of orthodontic patients utilizing the appropriate methods,” says Rasheed Khalifa, DDS, an orthodontist based in Manteca, Calif. “Most importantly, the specialist’s knowledge of human growth and development helps the specialist arrive at the correct diagnosis of the orthodontic problems, leading to better treatment results.

Rasheed Khalifa, DDS

“Addressing an improper bite or malocclusion in its various manifestations is the most common reason I treat orthodontic patients,” Khalifa says. “Common examples of improper bite are excessive overjet (often referred to as over-bite or buck teeth) under-bite, anterior deep-bite, anterior open-bite, individual tooth or teeth cross-bite, rotated teeth, spaced or crowded teeth.”

Although he typically recommends fixed metal braces for teenagers and ceramic fixed braces for adults, in some cases, patients can be fitted with clear aligners. But this isn’t the best option for every patient, he adds. “While clear aligners have made orthodontic treatment appealing to teen and adult patients who are not comfortable wearing braces, in some cases, they may not be the right choice for the correction they require.”

In fact, for some extreme cases, even traditional treatment with fixed braces will not suffice. For instance, to treat jaw abnormalities in growing children, Khalifa modifies their growth pattern utilizing myofunctional removable appliances. Gross skeletal jaw abnormalities in non-growing patients may require orthognathic surgical correction, such as orthodontics combined with jaw surgery, he says. Thanks to technological advances like digital X-ray and scanners and 3D printers, orthodontists can provide more accurate diagnoses and efficient treatment. And the incorporation of nickel/titanium alloy in arch wires and coil springs has nearly eliminated the need for pulling teeth in patients with crowded or underdeveloped jaws, he says.

A day’s work
On a typical day, Khalifa sees between 30 and 40 patients, either to place braces, make necessary adjustments, remove orthodontic appliances or check bite stability on patients already in retention. “The majority of these patients require adjustments, such as activating their orthodontic appliances by bending or changing arch wires and/or changing their elastomers,” he explains.

It’s common for a patient to schedule an emergency visit because an arch wire is poking his or her gums and must be cut flush. But, the day after Halloween traditionally is one of the busiest days of the year for emergency calls, according to Khalifa. Indeed, sticky, chewy or hard treats can play havoc on orthodontic appliances. “We promote the American Association of Orthodontists’ Orthodontic Health Month recommendations and post braces-friendly tips on social media, but we still end up with calls regarding broken braces and wires,” he says.

Emergencies aside, however, some patients simply are less motivated than others when it comes to complying with treatment, Khalifa says. Teens sometimes require regular encouragement to wear their removable elastics or maintain good oral hygiene, he says. “We talk to them and sometimes offer reward programs. In fact, we’ve improved compliance by offering patients points toward a monthly movie ticket drawing.”

That said, patients generally do what it takes to get the best possible results. “I emphasize to patients that straight teeth are easier to clean and lead to lifelong better oral and overall health,” says Khalifa. “From the patients’ perspective, they are very aware of the need for orthodontic treatment when their teeth are crooked, obviously spaced or they have a gross over or underbite. And social factors like social media and selfies have made the public even more conscious of their smiles.”

Greater competition
As more general dentists have added orthodontics at their practice, and patients have more options for treatment, orthodontists must work harder to market their services, according to Khalifa. “In order to remain competitive, orthodontists must market their practice heavily,” he says. “This can be accomplished the traditional way, by establishing good rapport with the referring general dentists. But I also recommend in-house marketing by the whole staff, which should reflect the desired image of the practice. This may include programs that keep patients and their families engaged with the office and the treatment, as well as community involvement.

“In this era of the patient experience, it’s especially important that orthodontic practices take full advantage of online and social media to reach their market niche, as well as offer contests and rewards to engage young patients and their families,” says Khalifa. Bottom line, he explains, orthodontists want to see patients benefit from an improved smile, facial appearance and oral health, and inevitably, better self-esteem.

News

DSOs, DENTAL PROVIDERS AND INSURANCE NEWS

Smile Brands, A+ Dental Care partner to expand dental services in Natomas, CA
Smile Brands Inc. (Irvine, CA), with its affiliate A+ Dental Care, announced the acquisition of Dr. Glenn Misono (Natomas, CA) and the opening of a new A+ location in Natomas. Dr. Glenn Misono has served the community for over 16 years. The practice will be rebranded as A+ Dental Care. A+ Dental Care is a rapidly growing group dental practice with seven locations across the Sacramento area. The group’s 14 general dentists and three specialists provide comprehensive, personalized dental care.

Carolina Family Health Centers receives $300K HHS grant for mobile dental care unit
Carolina Family Health Centers (Wilson, NC) received a $300,000 grant from HHS to purchase a mobile unit and expand dental healthcare. The mobile unit will take about 8 months to build. When complete, it will be equipped for dental screenings, X-rays, cleanings and procedures. The bus will also have space for medical care such as immunizations and physicals.

Missouri county health department opens its first dental clinic
The Missouri Health Department opened its first dental clinic in Dade County on Oct. 15. The new clinic will accept non-insured individuals, along with those with insurance or Medicaid. County residents previously had to drive up to 30 minutes to see the county’s only dentist.

Pacific Dental Services-supported dentist joins Virginia dentistry board
Michael Nguyen, DDS, was appointed to the Virginia State Board of Dentistry. The Virginia Board of Dentistry oversees licensed individuals who provide dental services within the state. As a board member, Dr. Nguyen will also review complaints against licensed dentists and unlicensed individuals. Dr. Nguyen is a dentist at the Dentists of Gainesville and Dentists of Sterling. His practices are supported by Pacific Dental Services (Irvine, CA), which supports more than 750 dental offices across the U.S.

Western Dental acquires California specialty center
Western Dental & Orthodontics (Orange, CA) acquired San Diego Dental Specialty Center (SDDSC), effective Sept. 30. SDDSC provides general dentistry and oral hygiene services and welcomes patients with all types of coverage, including Medi-Cal Dental. The practice also offers some orthodontics, pedodontics, endodontics, periodontics, and oral surgery, access to which will be expanded to be consistent with Western Dental’s multi-specialty care model. The transaction brings the total number of Western Dental offices in California to 231. Western Dental now supports a total of 322 offices in five states, including Alabama, Arizona, California, Texas, and Nevada.

OSAP selects winners of 2020 Anna Nelson, CDA, RDA, MA Scholarship
The Organization for Safety, Asepsis and Prevention (OSAP) (Atlanta, GA) selected the award recipients of the 2020 Anna Nelson, CDA, RDA, MA Scholarship. This scholarship was established in memory of Anna Nelson, CDA, RDA, MA, a leader in dental assisting and infection control, who passionately advocated to advance dental assistants’ understanding of, and compliance with, the guidelines, regulations, and best practices to prevent disease transmission in dental settings, OSAP said. The award recipients will receive 25% off the early-bird member rate for 2020 OSAP Dental Infection Control Boot Camp and one free year of the OSAP Premium Membership.

Signature Health gets $300k for dental services
Signature Health (Ashtabula, OH) was awarded $300,000 by the Health Resources Service Administration to provide dental services. Since 2016, Signature Health has been a federally qualified health center (FQHC) and expanded services beyond mental and behavioral health to primary care. As one of the 300 national grant winners, Signature Health plans to start offering dental services in fall 2020.

Walmart opens health center featuring dental care
Walmart has opened its first health center in Dallas, GA, with dental, optical, labs, and X-ray services, as well as community health education. The center promises transparent pricing. A patient exam that includes X-rays costs $25. Adult teeth cleaning starts at $25, and youth teeth cleaning starts at $15. Patients pay $225 for in-office teeth whitening, $75 for deep cleaning per quad, and $50 for emergency treatment for pain. A filling can cost between $75 and $125.

Smile Brands partners with Doerner Dental
Smile Brands Inc. (Irvine, CA) has partnered with Doerner Dental (Clearwater, FL). Smile Brands will provide full-service administrative support to the practice, including purchasing, payroll, accounting, IT, billing, facilities management and marketing. The existing staff will remain in place and the business will continue to operate under the Doerner Dental brand.

Minnesota Dental Association names Dr. Stephen McDonnell as president
Dr. Stephen McDonnell was installed as president of the Minnesota Dental Association (MDA) for the 2019-2020 term at the Association’s annual House of Delegates meeting in Duluth, Minn. In 2009 and 2012, Dr. McDonnell received Outstanding Service Awards from the MDA and the SPDDS. He is a fellow of the Pierre Fauchard Academy, Minnesota Chapter, and of the American College of Dentists.

Group of four Minnesota practices forms new group, Mosaic Dental
A group of four dentist offices have consolidated to create Mosaic Dental (Burnsville, MN). The group was formed from offices in Apple Valley, Burnsville and Eagan, Minnesota. The Mosaic model draws on the strengths of skills of four metro practices with a key differentiation being that local dentists retain ownership of their practice, while taking advantage of resources that only larger groups have been able to provide in the past, local news reported.

CDA encourages dentists to prepare for CDT 2020 dental code changes
The CDA is encouraging dentists to prepare for CDT 2020 dental code additions, revisions, and deletions that go into effect Jan. 1, 2020. The new year will bring 37 new and five revised codes, as well as six deleted codes. “While dental plans are required to recognize current CDT codes, it is important to keep in mind that they are not required to pay for or provide benefits for the new or revised codes,” the CDA advised. Dentists should review each dental plan’s payment and processing guidelines to see if benefits will be payable. Typically, plans will start sending updates about policy changes for the new year in late October and early November”

Gentle Dental opens 40th practice
Gentle Dental (Waltham, MA) opened a new office at 188 Needham Street in Newton, MA, bringing the total number of Gentle Dental practices to 40. The location will be led by Dr. Kunal Dani. This is the third practice Gentle Dental has opened this year. Gentle Dental is a practice of 42 North Dental Care, LLC (Waltham, MA).

Former ADA president Dr. S. Timothy Rose dies
Dr. S. Timothy Rose, who served as ADA president from 1998 to 1999, died Sept. 24. He was 77 years old. Dr. Rose had also served as president of the Wisconsin Dental Association, American Academy of Periodontology and as a trustee of ADA’s 9th District, chairing various committees. Born March 12, 1942, in Charleston, WV, Dr. Rose is a 1967 graduate of the Ohio State University College of Dentistry.


MARKET RESEARCH AND TRENDS

Improved root canal instrumentation to reduce dental-work complications
Reducing dental work complications is in best interest of dentists as well as patients. To improve clinical performance of root canal instruments, a research team tested instrumentation with specially designed rotary movements. The study, published in Journal of Endodontics, suggests that adaptive movement of nickel-titanium (NiTi) files improves the success rate of root canal treatment by lowering the torque generation of the instruments. A lower torque will help reduce the risk of tooth damage and file fracture. The scientists tested three types of instruments/movements for the root canal procedure:  The K3XF rotary system with 1) continuous rotary movement (XFC) or 2) adaptive movement (XFA), and 3) the Twisted File with adaptive movement (TFA), all from the endodontic product manufacturer Kerr Endodontics.

ADA expands policy on oral cancer detection to include oropharyngeal cancer
The American Dental Association (ADA) (Chicago, IL) recommends dentists conduct routine visual and tactile examinations for oral and oropharyngeal cancer for all patients, according to a resolution passed by the ADA House of Delegates in September. Resolution 65H-2019 amended the ADA policy on early detection and prevention of oral cancer to include oropharyngeal cancer and cover all patients, not just those previously thought to be at an increased risk because of tobacco and alcohol use. The amendments also align with the ADA policy approved by the House of Delegates in October 2018 that supports the use and administration of the human papillomavirus vaccine. The full resolution will be available to members by the end of the year.


U.S. GOVERNMENT AND REGULATORY TRENDS

HHS gives Florida health centers $4.6M for dental care
Sixteen of Florida’s community health centers have received grants to advance oral healthcare from HHS. The funds will be used to upgrade equipment, provide more integration between oral health services and primary care at the health centers, and expand service sites across the state. In total, HHS is investing $4.6 million across the nation to expand patients’ access to dental care. Federal funding for early detection and preventative dental care could decrease ER visits and the overall healthcare system cost, the ADA reported.

FDA to review safety of metal implants, dental alloys
The FDA announced it will evaluate metals used in implants and amalgam dental fillings to determine whether the devices are safe and effective. The announcement comes after several reports of adverse reactions to devices containing metal. Current evidence suggests that some people may be more susceptible to contracting an immune or inflammatory reaction when exposed to certain metals in implanted devices. Symptoms can be limited to the region where the device is or more generalized. Reported systemic symptoms include weakness, fatigue, rash, and joint or muscle pain.