DecisionOne Dental named one of the
Top Workplaces in Illinois by The Chicago Tribune
DecisionOne Dental has been named as one of the Top
Workplaces in Illinois by The Chicago Tribune as evaluated
by Energage, a national leader in workplace culture devel-
opment and employee performance research, according
to a release. The company was the highest ranked dental
business in Illinois regardless of size and No. 16 of all
mid-sized companies with 250-999 employees. Energage
has surveyed over 50,000 businesses nationwide to develop
its criteria to identify companies with excellent workplace
cultures. The Top Workplace designation was based on an
independent survey of DecisionOne Dental employees by
Energage. DecisionOne Dental is one of the fastest growing
dental service organizations in Illinois with currently 274
team members at 26 dentist offices across the Chicagoland
area and a support center based in Schaumburg.

“We’re really honored and humbled by this award,”
said Dr. AJ Acierno, CEO and co-founder of Decisio-
nOne Dental. “We created a company with a purpose
to put people – patients and team members – first and
that has drawn such an array of talented and dedicated
people to work with us, people who want to be a part of
our mission. For all of us this is so much more than just
a job – we are literally changing the way dentistry is done
to improve lives.”

Burkhart Dental hires John J. Klavon
as Special Markets Director
Burkhart Dental Supply announced the hiring of John J. Klavon as its Director of Special Markets. Klavon is a seasoned dental professional and proven leader with extensive expertise establishing and managing special (strategic) markets departments. In this new position, Klavon will assist and support Burkhart Dental Supply’s associates and special market customers in navigating the ever-changing environment of the dental industry. Klavon has 26 years of experience in the dental industry. He brings expertise in strategic account management, strategic vision and business planning, customer interaction, and sales management. Prior to joining Burkhart, he was Field Director Manager, Strategic Markets, for Benco Dental. Klavon is a graduate of Michigan State University with a degree in finance.

Heartland Dental reaches 900th supported office milestone
Heartland Dental (Effingham, IL) announced that it recently crossed the milestone of 900 supported offices. Heartland Dental reached this milestone this year by continually supporting the opening of brand new “De Novo” offices and affiliating with existing dental offices throughout the country. In 2018, the company increased its footprint to 37 states.

“Starting out with a handful of supported offices in a few states to now supporting 900 offices across the country, it’s been amazing to see how our company has grown in just a few decades,” said Patrick Bauer, President and Chief Executive Officer at Heartland Dental. “This is only the beginning. We will continue to make strides in our mission of becoming THE leader in dentistry, and look forward to celebrating many more of these mile-stones in the future.”

Smile Brands opens 23rd Washington office
Smile Brands (Irvine, CA) opened an affiliated Bright Now! Dental office in Kennewick, Washington. The new clinic is Smile Brands’ 23rd practice in Washington. It is also the first Bright Now! Dental to open in Kennewick. Robert Stockton, DDS, leads the new practice. He and his team offer orthodontics, Invisalign, oral surgery, periodontics and endodontics.

Aspen Dental launches national marketing campaign
Aspen Dental (Syracuse, NY) launched a new national marketing campaign. This is the first time the company has run a fully integrated campaign featuring national and local TV advertising, radio, paid search, and social media and more. Developed in partnership with HEAT and Deloitte, the “Yes Campaign” features “the real stories of nine patients of Aspen Dental practices opening up about the barriers they faced in accessing dental care and how Aspen Dental practices helped them get back on to the road to good oral health– and changed their lives in the process.”

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.

Rules, regulations and standards of care abound in the dental profession. In order for the dental team to comply, all team members must have a clear understanding of the requirements and mandates. In short, it can be overwhelming.

While the primary goal of the dental practice is to provide the highest quality patient care and the best patient experience – all while ensuring patient and staff safety – team members must be efficient, well-organized and competent in the completion of the tasks and duties related to the requirements and mandates. This creates a culture of standardization and calibration. The instrument processing protocols, how to prepare and turn over operatories, and hand hygiene are all examples of tasks that should happen like clockwork.  What to dispose of – the where and how of waste management – is also one of those tasks.  Dental team members who are unsure of the appropriate steps to take may be making costly errors that hurt the dental practice.

Managing medical waste in the dental setting
Let’s review the types of medical waste produced in the dental setting and the protocols for management and disposal. It should be noted that the Centers for Disease Control and Prevention (CDC) states that dental healthcare facilities should dispose of medical waste regularly to avoid accumulation, and any facility generating regulated medical waste should have a plan for its management that complies with federal, state and local regulations to ensure health and environmental safety. Also, dental team members handling waste should be trained in appropriate methods and informed of the potential hazards.¹

Having a clear plan, as well as understanding the risks involved, will streamline processes and productivity related to medical waste disposal. Many times, team members are confused with the terms defining the various types of waste. There are basically two types of waste generated in dental practices: regulated and nonregulated medical waste. General medical waste is defined as any solid waste that is generated in the diagnosis, treatment or immunization of human beings or animals in research pertaining thereto, or the production or testing of biologicals. (The term excludes hazardous and household waste.). Only a small percentage of medical waste is infectious and needs to be regulated.^2,3,4 Infectious waste, which is regulated, is a very small subset of medical waste (about 3 percent) that has proven to be capable of transmitting an infectious disease.³

The Bloodborne Pathogens standard uses the term regulated waste to refer to the following categories of waste, which require special handling:

• Liquid or semi-liquid blood or other potentially infectious material (OPIM).
• Items contaminated with blood or OPIM, which would release these substances in a liquid or semi-liquid state if compressed.
• Items that are caked with dried blood or OPIM and are capable of releasing these materials during handling.
• Contaminated sharps.
• Pathological and microbiological wastes containing blood or OPIM.⁵

Most of the regulated waste in dental offices consists of contaminated sharps and extracted teeth. However, other examples of regulated medical waste categories in dentistry, such as those listed above, include liquid blood or saliva; two-by-twos or cotton rolls saturated/caked with blood or saliva; used needles, scalpel blades, ortho wires, broken sharps instruments, burs, biopsy specimens and excised tissue.³

The practice management team must be certain that dental team members are trained and have a clear understanding of how to separate regulated waste from nonregulated waste to ensure a purposeful segregation. The practice incurs a cost from regulated waste because it must be picked up and transported off-site by qualified waste hauler vendors; therefore, only items that are considered infectious should be placed in regulated waste receptacles (commonly known as the red biohazard bags or red biohazard sharps containers).

Non-sharp regulated waste items, such as those listed above, must be disposed of in red biohazard bags. Contaminated sharps, however, must be disposed of in red biohazard sharps containers. OSHA points out that contaminated sharps shall be discarded immediately or as soon as feasible in containers that are closable, puncture resistant, leakproof on the sides and bottom and labeled or color-coded. OSHA also states that, during use, containers for contaminated sharps shall be easily accessible to personnel and located as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found, maintained upright throughout use, replaced routinely and not allowed to overfill. Lastly, when moving containers of contaminated sharps from the area of use, OSHA states that containers shall be closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport or shipping, and placed in a secondary container if leakage is possible. The second container shall be closable; constructed to contain all contents and prevent leakage during handling, storage, transport or shipping; and labeled or color-coded according to this standard. Reusable containers shall not be opened, emptied or cleaned manually or in any other manner that would expose employees to the risk of percutaneous injury.⁶   

The CDC recommends that sharps containers be located as close as possible to the work area.¹ Accordingly, every operatory should have a red biohazard sharps container, which should be stored in a place inaccessible to small children who could mistake a red container for a toy or surprise box.

Once procedures are complete, staff members should dispose of any disposable sharps in the operatory sharps containers. All other used items from patient care that have not been disposed of in red biohazard bags or sharps containers may be safely thrown out in the regular trash. Items such as barriers, gloves, masks, bibs, lightly soiled gauze and cotton rolls are not considered infectious or dangerous to the environment.³

Medical waste is primarily regulated by state environmental and health departments. The Environmental Protection Agency (EPA) has not had the authority to oversee the handling of medical waste since the Medical Waste Tracking Act (MWTA) of 1988 expired in 1991. It is important for the dental team to contact their state environmental program before they dispose of medical waste. They should contact their state environmental protection agency at www.epa.gov, as well as their state health agency, for more information regarding their state’s regulations on medical waste.²

It should be noted that the dental practice remains responsible for the regulated waste it generates until it is destroyed or rendered non-hazardous. This concept, which is called cradle-to-grave liability, means that even after waste leaves the practice, any cleanup for any damage it may cause is the responsibility of the generator (the practice); so, the practice should carefully select a licensed waste hauler.^3,4

Recordkeeping for the disposal of waste must meet state regulations. The most critical record is the waste manifest – a tracking document that comprises the name of the generator (dental practice), transporter, disposer and the waste itself. It also may include the description and quantity of waste, date, type of container and the type of final disposal.⁴   All manifest records must be kept for three years.⁴

The management of medical waste in a dental practice is a critical component of compliance to federal, state and local agency standards. Regardless of the practice size, all dental team members must be aware of what to dispose of, and how and where to dispose of it. Otherwise they risk taking a haphazard approach to the disposal of hazardous materials, causing potential risk to patients and staff, as well as the environment.

References

1. Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings — 2003. MMWR 2003;52(No. RR-17). Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm. Accessed November 18, 2018.

2. U.S. Environmental Protection Agency. Medical Waste. Available at https://www.epa.gov/rcra/medical-waste#who%20regulates%20medical%20waste. Accessed November 18, 2018.

3. Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team. 5th ed. St. Louis: Mosby Elsevier; 2013;192-196.

4. OSAP Interact Training System Workbook. OSHA and CDC Guidelines; Combining Safety with Infection Control and Prevention. 5^th Edition; 2017.

5. U.S. Department of Labor. Occupational Safety and Health Administration. Bloodborne Pathogens Standard; 1910:1030. Most frequently asked questions concerning the bloodborne pathogens standard. Available at https://www.osha.gov/laws-regs/standardinterpretations/1993-02-01-0#waste. Accessed November 18, 2018.

6. U.S. Department of Labor. Occupational Safety and Health Administration. Bloodborne Pathogens Standard; 1910:1030. Available at https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030. Accessed November 18, 2018.

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.

Infection Control

Growing attention to the hazards of contaminated dental unit water has led more dental clinicians to take the necessary steps to protect their patients.

There are no shortcuts to obtaining compliant dental water. Without the right products and protocols, however, dental practices will not be able to meet the acceptable standard for water delivered to patients during non-surgical procedures.

What’s more, even though compliance with water safety standards in the United States has not been required by law, that is changing.

“A dental practice simply will not achieve compliance without effective, EPA-validated products used in accordance with the correct protocols,” says Jerod Mendolia, marketing assistant, Sterisil, Inc. “At Sterisil, our philosophy is embodied in the acronym, PPC: Products + protocols = compliance. We have applied this methodology with great success in various settings, from mid-sized five-chair clinics to Ivy League dental schools.” New technology is important, he adds. But unless clinicians are educated on the appropriate protocols and develop a conscientious attitude, “we are setting them up for failure.”

A serious business
Because dental water is used as an irrigant solution in conjunction with high-speed rotary handpieces, potentially contaminated aerosols and spatter can carry waterborne pathogens through the air, increasing the potential for infections. Unwanted health implications associated with contaminated dental unit coolants range from the exacerbation of existing asthma symptoms due to endotoxin exposure to complex bacterial infections, such as Legionnaires’ disease, according to the Organization for Safety and Asepsis Prevention (OSAP). In recent years, two high-profile cases have linked dental unit water to serious infections, notes Mendolia. The first incident occurred at Dentistry for Children in Jonesboro, Georgia. A second incident occurred at Children’s Dental Group in Anaheim, California. In both cases, Mycobacterium were isolated as the cause of infections in pediatric patients who received a pulpotomy procedure with contaminated dental unit water, he points out.

Although the Centers for Disease Control and Prevention (CDC) has recommended that water delivered to patients during non-surgical dental procedures meet Environmental Protection Agency (EPA) standards for drinking water (<500CFU), some question whether this is sufficient in a clinical environment. “In 1995, the American Dental Association challenged dental unit manufacturers to develop the equipment necessary to deliver effluent handpiece water with <200CFU,” says Mendolia. That standard has since been raised to the <500CFU/ml drinking water standard. “Currently, there are many products on the market validated to deliver levels of disinfection well below 200CFU. I don’t think it is unreasonable to expect dental professionals to meet this higher standard considering the number of products and protocols available with advertised effectiveness claims at =10CFU.”

The right solution
For many dental professionals, the importance of delivering safe water during patient treatment is clear. Navigating their options, however, can sometimes be tricky. There are several methods available for treating water, notes Mendolia, and clinicians must stay informed in order to best serve their patients. There are advantages and disadvantages to each.

There are many filter options capable of removing some level of microbial contaminants, but without the presence of a residual disinfectant, filtration alone is insufficient to consistently maintain and prevent microbial growth downstream from the filter, according to Mendolia. For best results, filtration should be paired with an ion exchange-based product for shock and residual disinfection. “Clinicians should steer clear of filtration methods that require water storage in a tank,” he says. “Unless the practice has something like a UV light after the tank, water storage can lead to incubation of existing bacteria in the tank to >500CFU. Most waterline treatment products will have some sort of disclaimer stating for use with potable water. So, contaminated storage tank water would be unsuitable for use with many chemical treatments based on this alone.

“Since the introduction of the independent bottle reservoir, chemical treatments have become a viable and convenient method for reducing effluent dental water microbes,” he continues. “When dental clinicians follow the instructions for use (IFUs), they can expect good results. However, when using municipal tap water, they must do so with caution. Municipal contaminants like chlorine and copper can interfere with the efficacy of some chemical treatments. The best regimens will always feature both shock and maintenance treatments that are compatible with one another. Whenever possible, clinicians should use distilled water in their bottle reservoirs for the best results.”

In theory, in-office distillers are a viable solution, notes Mendolia. However, they are often associated with water test failures. “The machinery of distilling demands regular cleaning and disinfection to ensure the water purity and microbial viability,” he explains. “Once water has been heated into a gas and condensed back into liquid, it no doubt will be above room temperature. This increases the likelihood you are incubating bacteria as it’s stored. Without a residual disinfectant or some sort of shock treatment prior to introduction to the chair, it’s unlikely the 500CFU drinking water standard will be met, and the practice risks violating the manufacturer’s labeling.

“Don’t get me wrong,” he says. “Distilled water is much better than municipal tap water in just about every way. But physically distilling water is not the most effective method. Deionized water is essentially the same thing, and the process by which it is created does not increase the bacterial content. It is for this reason, all Sterisil systems employ this technology as the final purification step. Now you have a very pure base water to which a  residual disinfectant can be introduced, with minimal interference from microbes or chemical contaminates.”

Pre-sterilized water is clean enough for any dental procedure, says Mendolia. “However, once it is introduced into a dental chair, it is unlikely to meet the <500CFU standard,” he points out. “Unless the dentist intends to irrigate with single-use pipettes or purchase a very expensive sterile water generator, this will not be a viable option.” And, the cost of purchasing sterile water makes this an unaffordable option for many dental practices, he adds.

Mendolia recommends that dental practices use their bottle reservoirs for their intended purpose. “The independent bottle reservoir was designed to isolate the dental unit from municipal tap water and provide a conduit through which antimicrobial treatments could be introduced,” he says. “Tap water is not suitable for the dental setting for many reasons, but particularly due to the infinite variability in water chemistry. If clinicians are using residual disinfectants to control microbes in a dental chair, these details matter. Distilled water will always save the dental practice a lot of headaches in the end, trust me.

“Dental practices should always consult with their dental unit manufacturers and their waterline treatment providers about water testing,” Mendolia continues. “Minimum standards for water testing should be followed whenever possible, even though they are recommendations rather than requirements. If the dental practice’s protocols are in line with these standards, it is off to great start.”

A passing water test verifies the absence of bacteria and validates the dental practice’s disinfection efforts, he points out. “According to OSAP, dental practices should be testing within 30 days of introducing a new product or new protocols, and then every 30 days thereafter,” he says. “The initial test validates the product and protocol’s efficacy, and subsequent tests validate the protocol execution throughout the product’s lifespan (assuming the product did not expire prematurely). If both tests pass, the practice can begin testing every six months. If there is a test failure, the clinician should shock immediately and retest per the waterline treatment manufacturer’s IFU. I personally recommend testing through a third-party lab that specializes in dental water microbes, like Agenics They offer HPC counts and many other water chemistry metrics that help diagnose problems should they arise.”

Legal precedent
Compliance with water safety standards in the United States has not been required by law. But, that’s quickly changing. “Water compliance may not have been the law in 2016, when 73 pediatric patients contracted Mycobacterium infections from contaminated dental water at Children’s Dental Group in Orange County, California,” says Mendolia.  However, in 2019, it will become a law in California, he points out, noting that eventually much of the country will likely follow suit.

“What I try to impress on people is that this issue isn’t going away,” he says. “Now that there are legal precedents associated with patient vs. clinicians, and manufacturers vs. clinicians, with regard to this topic, it will be difficult for dental clinicians to prove in court that they are not responsible for any infections related to dental water in their practice, even if they weren’t legally required to take action.”

That said, for some dental professionals, cost will always be an obstacle. “We must focus on the relative cost per liter differences among the various products, relative to their overall need for water,” says Mendolia. “If a large practice intends to confront this problem head on, it would serve them well to go with the option that has the lowest cost per liter. That’s not always the lowest initial cost, but the purchase will pay for itself with time.

Sometimes dental practices just want to get their toes wet, so to speak. “Low cost options like Citrisil tablets are a good place to start, with the same great treatment you get from the higher end products,” he says. But, they’re not as convenient as a long-term solution. “The low-cost options in this category always leave something to be desired when it comes to efficiency and cost per liter.”

As more practitioners are on board with the need for waterline treatment, they are looking for solutions that provide enhanced efficiency and require less staff involvement, notes Mendolia. “We are here to help,” he adds.

Infection Control

By Howard Sorenson, vice president of sales, Porter Royal Sales Group

Sterility assurance depends on good design of the space designated for instrument processing.

First and foremost, steri-centers must be designed to comply with OSHA and CDC standards. In addition, a well-designed steri-center facilitates organization, efficient processing of dental instruments and the quick turnover of dental instrument setups.

In many cases, traditional straight-line steri-centers work very well. But older, U-shaped centers, which do double duty as supply storage areas, do not! That said, the use of modular dental cabinetry and some custom-built modules can make any size or shape of space become a functional efficient steri-center. And with the growth of larger group practices and DSO-type facilities, many practices require a mega-sized steri-center to accommodate the flow of staff and trays. A well-designed steri-center should incorporate the systemized processing of instruments, the use of cassettes, and protocols for color coding of instruments, handling biohazardous materials, cleaning instruments and storing sterile instrument setups.

Some points to consider when designing a steri-center include:

• Is the current steri-center in need of a face lift?
• How many procedures does the dental practice perform each day?
• What is the current protocol for procedure setups? (Using instrument cassettes not only saves time, but will reduce the amount of space required.)
• How does the practice currently process its handpieces?
• Do the material setup tubs match the practice’s instrument setups?
• How does the practice dispose of biohazardous materials?

It’s important to determine where to bring contaminated instruments into the steri-center, as well as where to leave sterile, ready-for-use instruments. In addition, it’s important to measure the space and identify electrical outlets, as well as where plumbing and lighting will go. (If necessary, is it possible to move any of these utilities?)

The large group practice

Designed by Biotech Inc

The large practice presents a unique set of challenges for a private practitioner. Given the magnitude of instruments that require processing, and the movement of staff entering and exiting the sterilization center, the space must be well designed to maximize efficiency and guarantee efficacy.

In one particular case, for instance, Biotech, Inc. created a steri-center with two entries: a pass-through from the hallway outside the space at one end for receiving contaminated trays, and a pass-through at the other end of the steri-center for the sterile trays to be picked up for use with the next patients. This design greatly minimized the staff traffic in and out of the work space.

Another possible bottleneck is having a single sink in these large practice steri-centers.  Having a double sink with two faucets, multiple Hydrim type washers, and ultrasonic cleaners need to be considered to prevent one area of the instrument processing from slowing down the recycle time.

Sufficiently analyzing the work flow and procedures completed at the practice, as well as consulting with the staff that does the instrument processing, help ensure the final steri-center design is best suited to each particular practice.

Infection Control

By Laura Thill

The look and feel of the reception area is important, but keeping it free of germs and infection is critical to the health of patients and staff.

The dental reception area is the initial point of reference for patients, who expect a clean, welcoming environment that attests to the professionalism of the practice. Anything less may make them think twice about returning, according to Lean Keefer, RDH, BS, MSM, director of clinical services and education, Crosstex, A Cantel Medical Company. “We never get a second chance to make that first impression,” she points out.

“The appearance of the reception area reflects the attitude and habits of the dentists and staff,” says Keefer. “It’s critical to make a positive, lasting impression. In addition, the reception area should be designed to optimize patients’ mood and well-being, as well as improve their perception and experience.” Patients are reported to comment more frequently on their experience in the reception area than on the dental team’s clinical skills, she adds. “Clinical care and staff/patient relationships are key to having patients return, but don’t underestimate the power of how the dental office presents itself to patients.”

Achieving the ideal look and feel of the reception area is only half the battle. Upper respiratory and seasonal illnesses are easily spread, making it imperative for the dental staff to follow regular infection control protocols. “Upper respiratory and seasonal illnesses can be spread through direct contact with mucous membrane; cross-contamination with clinical contact surfaces; and droplet transmission, including sneezing and coughing, which spreads the pathogens by large particle droplets that carry microorganisms,” says Keefer.

“People with flu can spread it to others up to about six feet away,” she continues. “Most experts think that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby, or possibly be inhaled into the lungs. Less often, a person might get flu by touching a surface or object that has flu virus on it, and then touching their own mouth, nose or eyes.” (https://www.cdc.gov/flu/about/disease/spread.htm)

People often misread their seasonal illnesses, Keefer continues. For instance, a sick person can be contagious before his or her symptoms appear. “If you have a cold, you’re contagious for one or two days before your symptoms develop and for two weeks after you are first exposed to the virus,” she says. “With the flu, people are the most contagious in the first three to four days after symptoms begin. However, it is possible to infect others a day before symptoms start. Children and those with weakened immune systems may pass the virus for longer than seven days.”

First lines of defense
The reception area receives heavy traffic, from early morning to evening. If left unattended, it inevitably will become cluttered with waste and carry the potential for cross-contamination, notes Keefer, who recommends daily cleaning and maintenance, with emergency cleanups throughout the day as needed. “The staff shouldn’t ignore details that can differentiate the practice,” she explains. “They should take 10 minutes to sit down and carefully view the reception area through the eyes of a patient.

“Boxes of facial tissues and pump bottles of alcohol-based hand rub should be appropriately placed for patient use in the reception area,” Keefer continues. “Wastebaskets with lids should be positioned for easy access to avoid used tissues being left on tabletops or hidden under chairs.” It’s also important to account for patient demographics when selecting and arranging furniture, she points out. “Given that some patients value their privacy and are concerned about other people’s germs, it’s better to arrange small groupings of chairs than line them up along the perimeter of the room.”

Posting respiratory etiquette and hand hygiene signs in the reception area can serve to remind patients to cover their coughs and wash their hands, she says, noting that posters may be downloaded from the following websites:

• http://www.health.state.mn.us/divs/idepc/dtopics/infectioncontrol/cover/
• http://www.health.state.mn.us/handhygiene/how/clean8.pdf

How clean is that surface?

Cold viruses have been shown to survive on surfaces for several days, while flu viruses are capable of being transferred to hands and causing an infection that can survive on hard surfaces for 24 hours.

The staphylococcus aureus bacteria that cause MRSA infections can survive for days to weeks on surfaces. MRSA bacteria can live on surfaces for longer than some other bacteria and viruses because they survive better without moisture. Generally, MRSA bacteria survive for longer on hard surfaces than on soft surfaces. Germs generally remain active longer on stainless steel, plastic and similar hard surfaces than on fabric and other soft surfaces. Other factors, such as the amount of virus deposited on a surface and the temperature and humidity of the environment, can also affect how long cold and flu germs stay active outside the body.

The dental staff should follow surface disinfection protocol for housekeeping surfaces using the appropriate chemical/cleaner and process with dwell time. That said, they should be mindful, as strong cleaning solutions used to kill germs can cause respiratory problems. They should wear appropriate personal protective equipment (PPE) during cleaning and maintenance, including a Level 1 ASTM face mask, safety eye protection and heavy-duty utility gloves, says Keefer. “PPE must be donned/doffed appropriately, and hand hygiene should be performed immediately after doffing PPE.”

It’s important to take a consistent, organized approach, she says. “Cleaning from high to low, and back to front, helps avoid dust and debris falling back onto the surface,” she explains. “Durable, washable surfaces – including both healthcare grade and those manufactured for commercial use – are easier to clean. Clean first, then use an appropriate level of sanitizer or disinfectant as indicated, based on the surface being treated. (The friction of cleaning removes most germs, leaving remaining germs to be addressed by the sanitizer or disinfectant.)

“Sanitizing reduces germs on inanimate surfaces to levels considered safe by public health codes or regulations,” says Keefer. “Disinfecting destroys or inactivates most germs on inanimate objects, with the exception of bacterial spores and prions. It is important to follow the manufacturer’s instructions for use and maintain the safety data sheet binder for any cleaning materials or products used in the office.

Microfiber cloths and flat mop heads are recommended due to their ability to pick up and hold dirt, as well as efficiently absorb liquid, notes Keefer. “The absorbency of microfiber is up to seven times its own weight in liquid, which is great for cleaning spills or glass surfaces, without leaving streaks.” It can be helpful to keep color-coded, microfiber cloths on hand for each purpose, she adds. “Using machine washable microfiber cloths can help cut the cost of disposable cleaning products, such as paper towels. By folding the microfiber cloth into thirds lengthwise, and then again in half provides, multiple clean surfaces during cleaning and dusting. And, it’s better to spray a cleaning/disinfecting product directly onto the cloth as opposed to the surface to reduce aerosol and respiratory hazards. In addition, she recommends adhering to the following protocols:

• Windows, doors, walls and mirrors. All floors, walls, surfaces, cabinets, drawers, and equipment must be capable of being quickly and easily cleaned and disinfected. Using a microfiber cloth, damp wipe vertical surfaces and ledges, paying particular attention to smudges and fingerprints; use a cleaning agent as needed.
• High Touch Surfaces. This includes – but is not limited to – door handles, cabinet knobs, light switches, remote controls, phones and sink faucets, which should be cleaned and disinfected daily with an EPA-approved disinfectant. If high-touch surfaces become visibly dirty, they should be immediately cleaned and disinfected.
• Regular vacuuming of upholstered items can refresh the fabric and keep furniture looking good. The dental staff should spot clean any fabric and use appropriate solutions for vinyl and leather surfaces. They should dust light bulbs and replace burned-out bulbs. Using plug protectors in electrical outlets help keep younger patients’ fingers safe.
• Tables and wood. All wood trim on furniture and tables should be dusted. A mixture of a cup of olive oil and a quarter-cup of white vinegar can nourish the wood and help it retain its shine. Plus, the vinegar is a natural germ killer. In addition, the furniture legs, the front of the reception desk and other surfaces should be scrubbed.
• Interactive toys. Toys, games and play equipment can be easily wiped clean. It’s helpful to limit toys to those that are washable, with fewer parts and smooth/flat surfaces. Colorfast, plastic toys can be disinfected using a solution of a ½ cup of bleach per gallon of water. Toys should be soaked for five minutes, then rinsed and air dried.
• Electronic equipment. Televisions, monitors and cords should be wiped with a dry microfiber cloth approved for electronics and no-scratch surfaces. The entire surface of remote controls, keyboards and mouse pads should be wiped. It’s particularly important to address buttons, which are a source of cross contamination. Alternatively, single-use disposable surface barriers may be used to protect electronics.
• Trash and Recycle Containers. Loose trash should be picked up throughout the day and properly disposed of. When checking the trash bin for emptying, staff should refrain from reaching into, or pushing on, the trash liner to compress the trash. Rather, they should leave the liner in container, close the top, and twist and tie a knot in the top of the bag. (When disposing of the trash bag, it should be carried away from one’s body.) All surfaces of the trash container should be wiped down with a surface disinfectant wipe and allowed to air dry before replacing it with a new liner.
• Carpets should be vacuumed daily using a HEPA filter, low decibel vacuum cleaner. They should be spot cleaned as needed, and cleaned every three months. Hard flooring should be cleaned using a broom or dust mop, followed by flat-head mop for light cleaning.
• Odors can be particularly offensive to patients and staff. A good ventilation system with charcoal filters can help minimize unpleasant odors. Cautionary use of disinfectant/deodorant sprays is recommended, as patients may be allergic or have respiratory concerns.

Throughout the day, the dental staff should practice proper hand hygiene. Washing hands with soap and water is the best way to get rid of germs. If soap and water are not available, an alcohol-based hand sanitizer (minimum 60 percent) is recommended. The staff should offer respiratory prevention packets (i.e., a disposable surgical mask, facial tissues and cleansing wipes) to all symptomatic patients. And, they should attempt to isolate all patients with suspected illnesses.

Loose items should be kept organized in containers, office policies should be saved in plastic sleeves in a three-ring binder, and magazines and pamphlets should be stored in clear plexiglas holders and wall mounts to keep them orderly. “While studies have shown low fomite contamination of the glossy pages, some offices are removing magazines from the reception area and asking patients to bring their own reading materials and children’s toys to reduce the risk of cross contamination,” says Keefer.

Infection prevention resources

Additional information related to respiratory hygiene/cough etiquette can be found in the 2007 Guideline for Isolation Precautions (available at: http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf). Recommendations for preventing the spread of influenza are available at: http://www.cdc.gov/flu/professionals/infectioncontrol/.

Did you know that dental items have been reported to be the second most common foreign object ingested or aspirated by adults? Zirc has developed Airway Armor, an innovative safety device designed to protect the patient’s airway. Airway Armor is the first of its kind on the market to serve as a barrier to swallowing or aspirating objects, allowing dentists to practice safely and confidently. This latex-free safety device is disposable and serves as a stable, comfortable, protective barrier in the mouth. It is easily placed and retrieved and is invaluable in all situations where other protective barriers are not viable options.

Airway Armor is a safe alternative to gauze packs, which typically cause patients discomfort. In addition, gauze packs can be difficult to place, absorb moisture and frequently need to be replaced. They have also been known to become lodged or aspirated into the airway, causing unnecessary risk to the patient. By contrast, Airway Armor is easy to place and durable, while giving practitioners full-mouth accessibility. It is available in three sizes – small, medium and large – to ensure a proper fit for any size mouth.

Dentists should ask themselves the following when considering Airway Armor:

• Is my practice doing procedures that expose our patients to the risk of ingesting or aspirating a dental object?
• What precautions do we take to protect our patients and our practice during these procedures?

Some dentists may have a few concerns, such as:

• “Will it make my patients gag?”
  • Flexible, yet durable, Airway Armor can be positioned within the mouth to keep most patients comfortable without gagging.
• “Why is the cost so high for a disposable item?”
  • Although Airway Armor is disposable, it is made of a durable material uniquely engineered to ensure its comfort, fit and effectiveness. It’s a simple, worthwhile precaution that can protect the practice from a costly malpractice lawsuit.

Airway Armor gives practitioners and patients alike peace of mind during treatment, including extractions, implants, restorations, orthodontics and pediatric procedures, by enabling them to provide the safest possible care to their patients.

Editor’s Note: Sponsored by Zirc.

Committed to better dentistry

Dental teams today face challenging sterilization workloads and strict regulatory requirements, making it more important than ever before to depend on a sterilizer that delivers optimal results, without sacrificing convenience.

At Tuttnauer, our single focus on sterilization and infection control enables us to offer products to help practitioners meet today’s challenging workloads and regulatory requirements. The EZPlus series fully automatic sterilizers meet the most current sterilization standards ANSI/AAMI ST55.

Both 9-inch and 11-inch models feature the dynamic air removal technology and an active closed-door HEPA filtered air-drying system to maintain sterility and ensure efficient drying of packs and pouches. In addition, the door remains closed throughout the dry cycle, encouraging the staff to leave the pouches/packs in the unit until all items are completely dry. This very important feature helps ensure the safety of patients, staff and doctors.

Dentists who are considering adding the EZPlus series should ask themselves several questions:

• How old is my sterilizer? Is it time to replace it?
• What type of sterilizer am I comfortable using? What model am I replacing and what chamber size does it have?
• Does my current model sterilizer meet all of the needs at my office?
• Does my office need to change from a manual autoclave to a fully automatic system? Will doing so free up time for the staff to work more closely with patients and assist with procedures that add to the bottom line?
• Has the volume of items to be sterilized at my office increased, decreased or remained the same? Do I need a larger, smaller or equivalent chamber size than I currently have?

Some dentists may question the best way to maintain an EZPlus autoclave:

• Regular cleaning and maintenance of a sterilizer is critical to keep the device in good working condition.
• Do not overload the sterilizer trays. Overloading sterilizers is the number one cause of sterilization cycle failures, including inadequate sterilization and drying.
• When using pouches, do not overlap or stack the pouches. Place pouches on trays in a single layer or use a pouch rack.
• Always use steam-distilled water with the physical characteristics detailed in the sterilizer manufacturer’s operator’s manual.

Tuttnauer is the only manufacturer to offer a two-year warranty on parts and labor, as well as an additional 10-year warranty on the chamber for all of its fully automatic autoclaves.

Editor’s Note: Sponsored by Tuttnauer U.S.A Co., Ltd.

Beautifil Flow Plus X, a durable NEW UPDATE to the latest-generation composite restorative, indicated for both anterior and posterior teeth, allows clinicians to place direct restorations with an excellent self-leveling ability and outstanding physical properties, absolutely equivalent to those of conventional hybrid composites. Thanks to its proprietary Giomer technology, NOW containing a patented nano S-PRG filler, Beautifil Flow Plus X benefits the adjacent tooth structure for sustainable caries prevention, while encompassing the ability to polish to a high and long-lasting luster.

The trilaminar structure of the bioactive S-PRG filler particles forms a stable zone of interaction, designed to sustainably release and recharge at high concentrations. The S-PRG filler releases fluoride and other bioactive ions inhibiting plaque formation and minimizing postoperative hypersensitivity. In addition, the filler particles buffer and neutralize acids.

A complete system for all indications
Beautifil Flow Plus X is an injectable hybrid composite available in two different viscosities, F00 and F03, for restorative build-up and filling. The newly developed thin-walled needle tips facilitate application directly from the syringe, allowing clinicians to easily and smoothly dispense the right amount of material at any time for precise direct restorations.

Beautifil Flow Plus X F00 (Zero Flow) and F03 (Low Flow) both provide optimal viscosities for anterior and posterior restorations. The flowability of F00 (Zero Flow) is so low that the material does not slump during layering. This easy-to-handle composite helps clinicians accurately restore the occlusal morphology, including cusps and marginal ridges. It flows well during application and has excellent shape retention while sculpting. By comparison, the self-levelling F03 (Low Flow) paste thoroughly wets the cavity walls, making it an ideal solution for filling. It can be used to line cavity floors, fill small occlusal cavities or create cervical restorations.

Beautifil Flow Plus X features improved mechanical properties, optimal polishability and a durable luster. Simple final polishing and excellent physical properties ensure superior long-term results.

The unique design of the needle tips ensures the paste neither sticks to the needle opening nor oozes at the end of delivery. Clinicians can easily and precisely shape occlusal posterior restorations without wasting material.

A reliable, state-of-the-art restorative system, Beautifil Flow Plus X includes nine common tooth shades, plus opaque dentin, enamel, bleach and effect shades, characterized by exceptional shade stability. This assortment covers all indications of direct restorative dentistry, allowing clinicians to meet all aesthetic requirements in both multi and single-layer techniques.

Editor’s note: Sponsored by Shofu.

Performing the right injection is the first step toward a pain-free patient experience.

Anesthesia is a first and essential step for most dental procedures. But dentists face a variety of issues when using a traditional syringe, such as:

• Adhering to the recommended injection time (One milliliter in one minute).
• Variations in pressure, which can damage tissue and cause discomfort to the patient.
• Keeping the quality of injections consistent throughout the day.

With the Dentapen, these challenges are greatly reduced.

Dentapen is a new generation of electronic syringe to perform pain free injections. Like most electronic syringes, the Dentapen injection is monitored with a constant flow, at the right pace. This gives dentists the opportunity to focus more on needle insertion¹, leading to better control of the injection and a reduction in pain for the patient. For instance, during a study done on 50 dentists who received a palatal injection, 96 percent of them preferred injections from an electronic syringe vs. manual syringe, and their pain perception was reduced by a factor of two².

What makes the Dentapen different is that it is a self-contained, cordless, intuitive device that matches dentists’ habits. There is no console, no foot pads, and no tubing or proprietary disposables. It can be held in two different ways – by the wings, like a manual syringe, or pen-like, for a precise injection during special procedures. Dentists can use any local anesthetic cartridge and their favorite dental needle. And patients find the small, modern look to be less threatening and more reassuring, helping them to relax.

For over 80 years Septodont has been a global influence in manufacturing dental materials and local anesthetics for the dental community.  Today they are a leader in pain management with a presence in over 150 countries with regulatory approvals to match.  For more information, visit www.septodont.com.

References:

1. Hochman, MN, Chiarello D, Hochman CB, Lopatkin R, Pergola S. Computerized Local Anesthesia Delivery vs. Traditional Syringe Technique.  NY State Dent J. 1997; 63:24-9.

Editor’s Note: Sponsored by Septodont.