March/April 2020


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Embracing diversity
Diversity within DSOs and group practices can lead to greater team satisfaction and better patient care

Publisher’s Note
Covering the topics you care about

Growing Dental Practices through Quality Content and SEO

A meeting place
Aspen Dental’s VIBE events offer a venue for practice owners and fourth years to make plans

It may fit like a glove…
…but is it the right fit?

Surface disinfectants
As products become more diverse, dental practices must find solutions that fit their needs

No one-fits-all solution
Gloves today are thinner – and offer greater durability – than their predecessors

Facemasks
Selecting comfortable, great-fitting masks for the dental team can be key in ensuring that they consistently wear them

United by their differences
When it comes to supporting a culture of diversity, actions speak louder than words

How do you do virtual?
Practical and tactical solutions for working remotely

The OSHA inspection
Complacency is unacceptable

2020 OSAP Annual Conference

The opioid crisis: It’s everyone’s responsibility
Mortenson Dental Partners does its part to address opioid addiction

News

Coming together

Publishers Letter

Scott Adams

I am incredibly excited to be the new publisher for Efficiency in Group Practice (EGP). This has been the fastest growing magazine in the history of our organization. For the past 11 years, I have been the publisher of our flagship title in the healthcare space, Repertoire Magazine.

EGP is a product of Atlanta-based Share Moving Media (SMM). As the owners of SMM, my business partner and I share a common goal with each of our publications: cover the topics our audience cares about and that will help them grow their careers. Our team is dedicated to delivering content to you that will help your career, enhance your work life and, hopefully, entertain you along the way. We will begin doing this through additional vehicles such as podcasts, live events and educational videos.

As you’re reading EGP, please think of topics we need to be covering or ways we can make it better and email me at sadams@sharemovingmedia.com. I look forward to getting to know you over the coming years. Thank you for subscribing to our publication.

Dedicated to Your Success,

Scott Adams

2020 OSAP Annual Conference

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 its 2020 OSAP Annual Conference May 28-30, 2020 at the Hyatt Regency Minneapolis in Minneapolis, MN. The conference is expected to bring together the most innovative thinkers in dental infection prevention, occupational health and patient safety, and will cover a wide variety of topics relevant to dental infection control, including evolving guidance, compliance, and emerging infection prevention and safety issues. Topical and authoritative information will be provided on the most relevant science, policies, procedures and resources for patient and provider infection control and safety.

After attending, participants will be able to:

  • Describe current and emerging issues related to infection prevention and safety in oral healthcare settings.
  • List new resources, tools and networks to optimize compliance.
  • Identify important attributes to develop and enhance global leadership for the optimal delivery of infection prevention and The Safest Dental Visit.

The target audience will include:

  • Clinicians.
  • Educators.
  • Infection control coordinators.
  • Consultants and lecturers.
  • Compliance officers of state dental boards.
  • Risk managers.
  • Policy makers.
  • Sterilization technicians.
  • Hospitals and Federally Qualified Health Centers (FQHCs) with dental clinics.
  • Companies engaged in infection control and safety products and services.

This year’s Zapp Lecturer (keynote speaker) will be Dr. Matt McCarthy. A New York-based infectious disease doctor and New York Times best-selling author, Dr. McCarthy most recently published his third book, Superbugs: The race to end an epidemic. In addition, he is an associate professor at Weill Cornell Medical College. Dr. McCarthy will bring a different dynamic to the conference: After playing baseball at Yale University, he played minor league baseball for one year. After he was cut from the minor leagues, Dr. McCarthy went to Harvard for medical school. For more information visit www.drmattmccarthy.com.

Pre-conference course
A pre-conference course – The Basic Training – Dental Infection Prevention and Safety Course – will be offered May 27-28, 2020. The fast-paced 1.5-day course will be presented by national and international experts in dental infection prevention and patient safety, and will provide a comprehensive review of the basics in dental infection control. Participants are expected to leave with new information and resources to help them better address their infection prevention and safety challenges, as well as meet new colleagues who share their interest in this critically important topic area.

This course offers 11 hours of CE credit plus a copy of the newly updated OSHA & CDC Guidelines: OSAP Interact Training System – 6th Edition workbook ($175 value), checklists, tools, and much more. Successful completion of the Interact workbook and corresponding assessment counts toward the education requirements for two certifications:

  • OSAP-DANB Certified in Dental Infection Prevention and Control (CDIPC) – A clinically focused professional certification.
  • OSAP-DANB Dental Industry Specialist in Infection Prevention and Control (DISIPC) – An industry-focused professional certification.

The target audience for this course includes Federally Qualified Health Centers (FQHCs), Indian Health Services (IHS), public health departments, and others. To learn more visit: dentalinfectioncontrol.org.

As of press time, the pre-conference agenda will include the following:

WEDNESDAY, MAY 27
TIME SESSION
6:30 – 7:30 AM Registration/Check-In and Refreshments
7:30 – 7:45 AM Course Overview and Greetings

LCDR Matthew R. Ellis, MPH, CIC, REHS and Joyce Moore, BSDH, RDH, CRCST

7:45 – 8:45 AM Introduction to Patient Safety

CAPT Stephen “Miles” Rudd, MD, FAAFP, CPPS

8:45 – 9:15 AM Principles of Infection Control

Shannon Mills, DDS

9:15 – 9:45 AM If Saliva Were Red Exercise Eve Cuny, MS
9:45 – 10:15 AM Refreshment Break with Exhibitors
10:15 – 11:00 AM Infection Control Coordinator Regulatory Guidance & Standards Overview

Kathy Eklund, RDH, MHP

11:00 – 11:30 AM Sharps Safety

Eve Cuny, MS

11:30 – 11:45 AM Panel Questions and Answers

All speakers from morning

11:45 AM – 12:45 PM Lunch with Exhibitors
12:45 – 2:00 PM Sterilization & Disinfection of Patient Care Instruments

Eve Cuny, MS

2:00 – 2:45 PM Personal Protective Equipment, Respiratory Hygiene/Cough Etiquette and Hand Hygiene

Kathy Eklund, RDH, MHP

2:45 – 3:15 PM The ABC’s of Infection Prevention in Dental Settings

Diane Cullen, RN, MSN, MBA, CIC

3:15 – 3:45 PM Refreshment Break with Exhibitors
3:45 – 5:00 PM Surveillance & Breaches in Infection Control in Dentistry

Patty Montgomery, MPH, RN, CIC

5:00 – 5:15 PM Panel Questions and Answers

All speakers from afternoon

THURSDAY, MAY 28
TIME SESSION
6:45 – 7:30 AM Refreshment Break with Exhibitors
7:30 – 8:30 AM Dental Unit Waterlines

Shannon Mills, DDS

8:30 – 9:15 AM Environmental Infection Control

Eve Cuny, MS

9:15 – 10:00 AM Immunizations and Work Restrictions

Shannon Mills, DDS

10:00 – 10:30 AM Refreshment Break with Exhibitors
10:30 – 11:00 AM Preview of the OSAP-DALE Foundation Dental Infection Prevention and Control CertificateTM Program
Eve Cuny, MS and Kathy Eklund, RDH, MHP
11:00 AM – 12:00 PM Leading Your Team to The Safest Dental VisitTM

Eve Cuny, MS, Kathy Eklund, RDH, MHP, LCDR Matthew R. Ellis, MPH, CIC, REHS, and Shannon Mills, DDS

12:00 PM – 12:15 PM Closeout/Panel Questions and Answers

All speakers from morning

 

As of press time, the 2020 OSAP Annual Conference agenda will include the following:

THURSDAY, MAY 28
TIME SESSION TITLE
6:30 AM – 5:00 PM Check-In/Registration
1:00- 1:30 PM OSAP First Timers Orientation

Michelle Lee, CPC

1:30 – 2:00 PM OSAP Membership Business Meeting

Michelle Lee, CPC

2:00 – 3:00 PM Do You See What We See? Common Accreditation Findings in Dental Clinics and What You Can Do to Prepare
Diane Cullen, RN, MSN, MBA, CIC
3:00 – 4:00 PM Amalgam Separator Rule

Fred Eichmiller, DDS, MS

4:00 – 5:00 PM Surface Disinfectants

John Molinari, PhD

6:00 – 9:00 PM Welcome Dinner

Included in “Annual Conference ONLY” and the “Basic Training and Annual Conference” registration fee. Guest tickets are available for an additional fee.

FRIDAY, MAY 29
SESSION TITLE
7:00 AM -5:30 PM Check-In/Registration
7:00 – 8:30 AM Refreshment Break with Exhibitors
8:30 – 9:30 AM Dr. John S. Zapp Global Lecture- Superbugs: The Race to Stop an Epidemic

Matt McCarthy, MD

9:30 -10:00 AM Opening Ceremonies and Awards

Michelle Lee, CPC

10:00 -10:30 AM Refreshment Break with Exhibitors
10:30 -11:30 AM Eye Protection Panel Discussion

James R. Harris, PhD, PE, and James Mace, DDS Moderator: Shannon Mills, DDS

11:30 AM – 1:00 PM Lunch with Exhibitors
12:00 -1:00 PM Abstract Poster Presentations
1:00 -2:30 PM State Waterline Regulations Panel Discussion

Matthew J Arduino, MS, DrPH, FSHEA, M(ASCP)CM and David L. Carsten, DDS Moderator: Shannon Mills, DDS

2:30 -3:00 PM Refreshment Break with Exhibitors
3:00 -4:00 PM The Role of Bacterial Biofilms in Compromised Cleaning and Sterilization Failure

Greg Whiteley, PhD

Danger Things: Patient Safety Hot Topics

Jen Hawley Price, MS, Ginny Jorgensen, CDA, EFDA, EFODA, AAS and Michele Lash, RDH, BA

Space is limited.

Creating a Culture of Safety in Dentistry: One Specialty’s Journey

Paul S. Casamassimo, DDS, MS

Update in Dental Traumatology

Juan Yepes, DDS, MD, MPH, MS, DrPH

4:15 -5:15 PM TB Program Management

Sapna Bamrah Morris, MD, MBA

6:00 – 8:00 PM Reception and Live Fund Raising Auction!
SATURDAY, MAY 30
SESSION TITLE
6:30 AM – 5:00 PM Check-In/Registration
7:00 – 8:00 AM Refreshment Break with Exhibitors
8:00 – 9:30 AM CBCT: Good, Bad and Sometimes……Ugly!

Juan Yepes, DDS, MD, MPH, MS, DrPH

9:30 -10:30 AM Occupational Exposures

Brie Blackley, MS, PhD

10:30 – 11:00 AM Refreshment Break with Exhibitors
11:00 – 12:00 PM Antibiotic Stewardship

Sanjay Chand, MD

The Role of Bacterial Biofilms in Compromised Cleaning and Sterilization Failure (Repeat) Greg Whiteley, PhD
Danger Things: Patient Safety Hot Topics (Repeat)
Jen Hawley Price, MS, Ginny Jorgensen, CDA, EFDA, EFODA, AAS & Michele Lash, RDH, BA Space is limited.
Update in Dental Traumatology (Repeat) Juan Yepes, DDS, MD, MPH, MS, DrPH
12:00 – 1:15 PM Lunch
12:15 – 1:15 PM Breakout Discussion: Update on ADA, AAMI and ISO Standards

Fiona Collins, BDS, MBA, MA and Shannon Mills, DDS

Breakout Discussion: How to Handle a Breach

Patty Montgomery, MPH, RN, CIC

1:30 -2:30 PM Dental Unit Waterlines – All the Options

Shannon Mills, DDS

2:30 -3:00 PM Stretch Break
3:00 – 4:00 PM Hidden Dangers in Dental Patient Safety

Steven Yun, MD

Antibiotic Stewardship (Repeat) Sanjay Chand, MD
Make Your Safety Message Stick: Top 5 Strategies for Building Safety Culture

Kandis V. Garland, RDH, MS

Space is limited.

Balancing Infection Control and Clinic Efficiency: Finding the Sweet Spot Where Risk Mitigation Meets Profitability in the Dental Clinic
Olivia Wann, JD
4:15 -5:15 PM Opioid Safety and Alternatives in Dental Pain Management

Steven Yun, MD

6:00 -9:00 PM OSAP Saturday Night Social – River Cruise

Not included in registration – additional fee required.

Registration
OSAP member registration fees apply to all membership levels above Basic. Members must log into their OSAP account to receive the member rate. The Welcome Dinner will be included in the Annual Conference and Basic Training/Annual Conference registration fee only. It will not be included in the Basic Training/Dental Infection Prevention and Safety Course fee. However, guest tickets are available for purchase.

In addition, conference participants will be able to purchase tickets to a Saturday Night river cruise.

Conference rates are as follows:

 OSAP Member * Early-bird Rate
(by 3.31.20)
Regular Rate
(by 5.14.20)
On-Site Rate
(after 5.14.20)
 Annual Conference ONLY  $645 $725 $805
 Annual Conference ONLY – Additional Attendee $545 $625  $705
 Basic Training: Dental Infection Prevention and Safety Course ONLY   $345 $345 $345
 Basic Training + Annual Conference   $845 $845 $845
 Welcome Dinner – Additional Guest (per person) $100 $100 $100
 Saturday Night Social – River Cruise (per person)  $100 $100  $100

*Those with Basic (online membership) will receive Non-Member pricing.

Note: Students please contact OSAP for the student rate.

Non-Member  Early-bird Rate
(by 3.31.20)
Regular Rate
(by 5.14.20)
On-Site Rate
(after 5.14.20)
Annual Conference ONLY $800 $880 $960
Annual Conference ONLY – Additional Attendee $700 $780 $860
 Basic Training: Dental Infection Prevention and Safety Course ONLY $345  $345 $345
 Basic Training + Annual Conference $845  $845 $845
 Welcome Dinner – Additional Guest (per person) $100 $100 $100
 Saturday Night Social – River Cruise (per person) $100 $100 $100

To ensure they can accommodate everyone’s needs, OSAP requests registrants indicate any requirements on the registration form. Questions may be directed to OSAP at Office@OSAP.org.

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 continuing education credits will receive a CE verification form to record the CE numbers for the specific courses they attend. To receive continuing education 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 maintain their CE verification form as proof of participation in the educational programming.

Cancellations, refunds and substitutions
All registration cancellations and refund requests must be made in writing by May 14, 2020. An 80 percent refund of conference fees will be given for cancellations received by March 31,2020. A 50 percent refund of conference fees will be given for cancellations received between April 1, 2020, and May 14, 2020. No refunds will be granted for requests postmarked after May 14, 2020. Submit all requests 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/refund policy must be submitted in writing by the registrant with appropriate documentation no later than May 14, 2020. After that time, no refund considerations will be made.

Substitutions within this program are gladly accepted. A substitution of one’s full registration is permitted prior to the conference by submitting a written request to office@osap.org. Onsite transfers are not 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 are 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’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 one is the subject of unacceptable behavior or has witnessed any such behavior during conference events, please contact Michelle Lee, OSAP’s Executive Director at 404-944-4824 or MLee@osap.org.

news

DSOs, Dental Providers and Insurance News

Marquee Dental acquires practice in Alabama

Marquee Dental Partners (Nashville, TN) announced it has acquired Dr. R. Scott Gamble, Cosmetic and Family Dentistry. Dr. Gamble has practiced in the Dothan, Alabama community for over 15 years. This partnership enables him to focus on serving his loyal patients and the growing number of new patients seeking his services, Marquee said.

MB2 Dental opens 200th practice

MB2 Dental (Carrollton, TX) announced that it has added three new partners and expanded into Connecticut. The new additions bring MB2’s office count to 200 practices across 13 states in the U.S. New MB2 Doctor Owner, Dr. Glenn Vo was the official 200th practice and is also known for his dental discounts website, Nifty Thrifty Dentists, a resource for dental professionals, along with his Nifty Thrifty podcast and Facebook group where he interviews fellow dentists and industry experts.

Pankey Institute names Brady president, CEO

The Pankey Institute promoted Lee Ann Brady, DMD, to the role of president and CEO. Brady was the Pankey Institute’s first female resident faculty member and later was promoted to clinical director. She will continue in her role as director of education while serving as president and CEO.

Bellevue Orthodontics launches same-day clear aligners using 3D printing

Bellevue Orthodontics (Bellevue, WA) announced that its patients can now get clear aligners for teeth-straightening on their first appointment. Patients have access to fully customized clear aligners such as “Movement Aligners” and customized product packaging.

Marquee Dental Partners solidifies growth through refinance

Marquee Dental Partners (Nashville, TN) recently refinanced its existing credit facility, securing a commitment from Crestline Investors, Inc. (Fort Worth, TX) to support its ongoing growth initiatives. The new structure provided capital support in Marquee’s close of seven recent acquisitions in 2019. The company says the funds will further be used for additional acquisitions, de novos, and general corporate operating expenses. Terms of the deal were not disclosed.

Aspen Dental signs deal for new lease in Chicago, will expand workforce

Aspen Dental Management (Syracuse, NY) has signed a lease for roughly 200,000 square feet at a 19-story office building under construction at 800 W. Fulton Market (Chicago, IL). The deal also includes 8,000 square feet of retail space in the building. The new space will be a large expansion from the 50,000 square feet the company occupies nearby at 1040 W. Randolph St., where it opened an office in 2018.

Mayo announces pilot dental services for children

Mayo Clinic Health System (Mankato, MN) has announced a pilot project that will expand preventive dental services for children at Eastridge Clinic. The announcement coincided with National Children’s Dental Health Month in February. Funded through grants from Mankato Area Foundation and Delta Dental, several dental services are now being offered to children up to the age of 18, including oral exams, dental cleanings, X-rays and application of fluoride varnish and sealants. The expansion of services aims to help address the wide disparities in oral health care access for vulnerable and underserved populations.

Bright Now! Dental opens new office in Los Angeles

Smile Brands Inc. (Irvine, CA) announced the opening of another affiliated Bright Now! Dental office in Los Angeles, CA. The newest Bright Now! Dental office provides full-service general dentistry, as well as orthodontics, Invisalign, oral surgery, periodontics, endodontics, and implants. The office will be led by Dr. Jereme Berryhill.

ADA announces new SVP of operations

The American Dental Association (ADA) has promoted Robert Quashie to the role of SVP of operations. In his new role, he will oversee the ADA’s technology division, along with its member and client services division. The technology division enhances the association management systems, which support ADA and local dental strategy, while the member and client services division works to expand the organization’s membership. Prior to his promotion, Quashie was VP of business operations and strategy for the ADA.

Texas awards new contract to DentaQuest for Medicaid, CHIP

Texas’s state department of Health and Human Services recently awarded DentaQuest a contract to continue providing dental managed care to enrollees in Texas Medicaid and CHIP programs. DentaQuest has been a partner to the State of Texas since 2012, providing Medicaid and CHIP dental benefits and currently serves about 1.5 million Medicaid and 229,000 CHIP beneficiaries throughout the state. Operations for the new contract begin Sept. 1, 2020.

ADA amends religious diversity policy to be more inclusive

The American Dental Association (ADA) in an effort to advance it’s diversity and inclusion efforts, the ADA House of Delegates voted at its meeting in September to rescind the policy titled “The Dentist’s Prayer,” used by some state and local dental societies during their meetings, and amend its policy on recognition of religious diversity. The ADA Board of Trustees had charged its Diversity and Inclusion Committee with considering the role of faith and religion in the Association, as well as The Dentist’s Prayer, following a House vote in 2018 referring the prayer for further study and report. In amending the recognition of religious diversity policy, the House resolved that Association meetings may begin with “a personal moment of reflection or silent prayer.”


Market Research and Trends

National study finds dental practices do poor job of using internet marketing resources

New research released through DMscore indicates significant performance gaps in digital marketing execution for dental practices, despite billions of dollars in marketing spend. Digital continues to be under-utilized throughout SMB professional marketing channels, including paid search advertising like Google Adwords, directory presence like Yelp and search engine optimization (SEO). The recent DMscore study reveals that few dentists optimize their practice’s marketing efforts. For example:

  • Nationwide, 71% of dentists have a Yelp profile, but 20% of the profiles are “unclaimed” by the practice, and
  • Over 33% of dental sites had poor organic search results, resulting in lower visibility and business loss.

“Root Canal” listed as most searched-for procedure on cost-compare website

Healthcare cost transparency website, FAIR Health Consumer, has released year-end statistics for 2019 that shed light on how a healthcare cost transparency site can attract a broad range of users as well as results on what medical and dental procedures site users were most interested in looking up. The site includes medical and dental cost-lookup tools that it says allow users to search for typical costs of healthcare procedures in their geographic areas. For both last year and 2018, the top five dental terms searched for with FAIR Health Consumer’s medical cost lookup tool were:

  • Root canal
  • Crown
  • Orthodontic
  • Cleaning
  • Implant

Sale of .org domains could have big impact on healthcare

The Internet Society in November announced its intent to sell control of all .org domains to private equity firm Ethos Capital for $1.1 billion. The sale and its implications have generated outrage and worry among .org users – including the many healthcare nonprofit organizations that would be affected.

Since 2002, domains ending in .org have been purchased through an agency called the Public Interest Registry, which is owned by the Internet Society, a well-regarded nonprofit working to expand access to the internet across the world. One worry of the proposed sale is that Ethos, to make the .org top-level domain as profitable as possible, will rapidly raise prices for its customers.

Currently, .org is an open domain, so anyone can register a .org domain, and there are more than 10 million registered worldwide. But the Public Internet Registry has the authority to suspend domain names for illegal activity, and one of the concerns raised in a public letter opposing the sale is the potential for governments to target NGOs by accusing them of illegal activity and pressuring the Public Internet Registry to take down their domains. This could have serious implications for the many healthcare nonprofits who use .org addresses.

Large number of Americans willing to go out of country to get lower cost care

One-fifth of people enrolled in a health insurance plan are willing to travel outside of the U.S. for care, with 60% of them already having done so for dental treatment. A recent survey has found that nearly 20% of Americans enrolled in a health insurance plan are willing to travel outside the U.S. for care – and that nearly 60% of them have already done so. Nearly 74% of respondents cited the possibility of lower costs as the reason for their willingness to travel. A total of 1,860 responses were tabulated in a voluntary survey of eHealth consumers who purchased Medicare plans or individual and family plans under the Patient Protection and Affordable Care Act.


U.S. Government and Regulatory Trends

U.S. Congress members write letter to FDA, FTC regarding SmileDirectClub

The American Association of Orthodontists (AAO) (St. Louis, MO) announced that, on Jan. 6, nine members of the U.S. House of Representatives authored a letter to the FDA and FTC “to express concern regarding SmileDirectClub.” Additionally, the Congressmen expressed their “strong support of the FDA and FTC investigating the practices of SmileDirectClub to ensure that it is not misleading consumers or causing patient harm.”

Maine considering bill to abolish insurance waiting periods for children

Members of Maine’s state legislature’s Committee on Health Coverage, Insurance and Financial Services have discussed an issue brought up by pediatric dentists around the state. Many of the dentists say they’ve had children whose dental care had to be delayed because of insurance waiting periods. A new proposed bill (LD 1975) would abolish insurance waiting periods for anyone under the age of 19, with an exception for orthodontic care.

Lack of access to dental care causing oral health epidemic in Oregon

Oregon is facing a dental health epidemic, and a lack of access to care is at the root of the problem for many children, rural residents and low-income families. Legislators will consider improving access to education and services in schools, as well as creating licensing for a new type of practitioner who can complete many of the same tasks as a dentist, but at a lower cost.

In the House, the Oregon Community Foundation has partnered with state Rep. Cedric Hayden (R-Roseburg) and Rep. Alissa Keny-Guyer (D-Portland) to pass the “Healthy Teeth, Bright Futures” campaign. The program would direct Oregon school districts to include age-appropriate dental health instruction as part of their health education.

The opioid crisis: It’s everyone’s responsibility

Dr Britt Bostick

By Dr. Britt Bostick, ​executive vice president and vice president of clinical affairs, Mortenson Dental Partnersc

Mortenson Dental Partners does its part to address opioid addiction.

The misuse of opioids — including prescription pain relievers, heroin and fentanyl — has become alarmingly common in recent years. According to the ​Centers for Disease Control and Prevention (CDC), opioid-related deaths surged between 2000-2017, and the ​National Institute on Drug Abuse​ estimates that more than 130 people die each day as a result of an overdose. The debilitating effects of the epidemic have become so devastating that the ​U.S. Department of Health and Human Services​ declared a public health emergency in 2017.

What role has the dental industry played in the growth of this national epidemic? A recent study published in ​JAMA Network​ found that dentists wrote more than 11.4 million opioid prescriptions in the United States alone in 2016, accounting for 22.3% of all U.S. dental prescriptions. Moreover, the ​National Institute of Dental and Craniofacial Research​ (NIDCR) found that dentists were the highest opioid prescriber group for patients between the ages of 10 and 19 years. Clearly, the dental industry has an obligation to do all it can to help mitigate this crisis.

Mortenson Dental Partners (MDP) is one of the largest groups of privately-owned dental practices in the United States. We have a responsibility to our patients to carefully consider the risks and benefits of any medications we prescribe. In recent months, MDP formed a committee comprised of executive and business intelligence team members to tackle this important issue.

As a result of the committee’s research and deliberations, MDP is pleased to announce three primary initiatives for helping to prevent opioid addiction:

  • Standardize the pharmaceuticals lists across all offices.
  • Continue to monitor prescribing habits of doctors.
  • Support the national effort to reduce narcotic dependencies.

The first of these initiatives will help to provide a more accurate picture of all prescriptions being dispensed by MDP providers. Standardizing the pharmaceuticals lists will allow us to better track all scripts to compare and educate across all regions.

As we closely monitor trends across MDP regions, we are seeing great progress in our efforts to minimize opioid prescriptions. We are happy to report that between 2016 and 2019, the total number of narcotic pills dispensed by MDP providers dropped by 48%. Our doctors are also writing 31% fewer scripts than in 2016, with the average number of pills per script falling from 16 to 12.

While we are grateful to have made these strides, there is still more work to do. We continue to educate our team and encourage our doctors to prescribe alternatives to opioids, such as nonsteroidal anti-inflammatory analgesics, as the first-line therapy for acute pain management. Our doctors also adhere to ​CDC guidelines​ and use the lowest effective dose and quantity whenever they do consider an opioid prescription.

The health and safety of our patients is of utmost importance to the entire team at MDP. We are committed to supporting the national effort to reduce narcotic dependencies and are doing whatever we can to help end this terrible epidemic.

How do you do virtual?

By Kristine Berry, RDH, MSEC

Practical and tactical solutions for working remotely

We are living in a world of rapid digitization and disruption. Two decades ago, each dental practice was largely constrained to one geographic location. Each practice was also mostly relegated to one office and was running operations in a face-to-face context. Technology has made the world a smaller place, yet most dental organizations are still facilitating conversations, learning and team development events using old methodology. This article highlights communication channels and effectiveness, as well as six foundational components designed to create engaging and effective virtual conversations.

Learning and leadership

Professionals of all stripes work virtually and remotely – from regional and district leaders within a dental service organization to dentist-owned multi-location dental practices, sales professionals and practice management consultants. Given that there is such a wide definition of what it means to work virtually and remotely, you are encouraged to approach this article through the lens of what makes sense for you (regardless of whether you are a team leader, regional manager, CEO, CFO, entrepreneur, internal coach or trainer, sales professional or part of an interdisciplinary healthcare team), as well as your groups or teams.

Two areas that are rapidly changing are learning and leadership. Virtual and remote teams can be defined as global, or as spanning a big urban center, state or region. A lot of organizations must look at how they do virtual, including how they can boost the virtual team’s effectiveness, engagement and/or presence and the organization’s bottom line. This leads to new challenges, such as the Zoom call, where employees and leaders find themselves dialing from one call to another, often being talked at rather than conversed with. Many see this as a chance to multitask, placing one meeting on mute while catching up on the to-dos assigned from another, as overwhelmed team members juggle a load of competing priorities that all need to be done immediately, across multi-locations and regions.

Gallup has found that in most North American workplaces, employee engagement numbers haven’t changed much since 2000; today, only around one-third of employees are engaged.  Consider that 11 billion meetings take place every day, with a third of them noted to be ineffective, and $37 billion is wasted every year on ineffective meetings. This leads to new challenges and principles for creating engaging and effective virtual meetings. As more organizations and professionals start to operate in the remote and virtual domain, it is vital to develop skills and confidence that help build connections with remote team members, facilitate meetings and help transition most activities to the virtual realm.

Engaging conversations in virtual meetings – defined as impactful, intersecting, interactive, important and meaningful – invite the participant to be present and participate in dialogue, shape discussions and move the initiatives and topics forward. Effective suggests relevant, practical, implementable, accountable and sustainable results, which often are missing from virtual exchanges. As someone who has worked remotely since 2004, it’s been amazing in the last 16 years to see how quickly things have changed.

Communication in the remote ecosystem

Understanding effective communication in the remote space is vital. Why?

The answer is found in a quote by Kim Krizan from the movie Waking Life:

“Language comes from our desire to move beyond our isolation and have some sort of connection with one another. Words by themselves are lifeless, they’re inert. They’re nothing more than symbols. So much of our experience is intangible; so much of what we perceive cannot be adequately expressed. And because of that, when we communicate with one another, and we feel we’ve connected, that we’re understood – it’s almost like having a spiritual communion with that person.”

We all want to connect with one another. When we connect, we feel a special affinity with the person who we believe really understands us. Communication is how our message is delivered and how it is received. It is two-way, involving both the sender and the receiver. The ecosystem of virtual conversations includes:

  • Phone and/or text.
  • E-learning; synchronous or asynchronous training.
  • Visual education events that are instructor/facilitator led through webinars, e-leaning and webcasts, teleseminars.
  • Video-based calls/learning.
  • Virtual meetings (formal and informal).
  • Goal-setting via strategic planning sessions and virtual retreats.
  • Mentored conversations. Experienced professionals can be partnered with those with less experience.
  • Group or team coaching focused on implementation, awareness, goal setting and ongoing responsibility and accountability for sustainable results.
  • Virtual team development, from virtual team meetings to virtual retreats and team coaching.
  • Peer-to peer learning with masterminds and breakouts.

What virtual teams and leaders need to consider is that effective communication involves not only words, but their body language, the voice they use and their ability to really listen.

Research shows that:

  • The words we use contribute 7% to the effectiveness of our message.
  • The quality and tone of our voice make up 38% of the message we send.
  • Body posture, facial expressions and gestures contribute to 55% of the message we send.

Our beliefs are conveyed more clearly through our body posture, facial expressions and gestures than our words. As a result, context and emotions are frequently missing or misinterpreted, depending on the mode. During phone-based conversations, we lose the visual signals and consciously or unconsciously focus on the words and the pitch of voice we hear (especially when we multi-task). When talking on the phone, our tone plays a key role, as well as how quickly we speak.

Many of us overlook this in our daily conversations. Yet, this is where we, as listeners, turn to get our cues. Many of us live in a never-ending email, text world or application, such as WhatsApp. In 2015, WhatsApp surpassed the number of texts per day: 30 billion texts from 750 million users. It is estimated that in a single day, the average North American sends five times more texts than the number of phone calls they make. When using these modes, we often lose context and miss cues that define the sender’s meaning and intent. This naturally creates challenges. Hint: Face to face conversations or video chats are recommended when an emotionally charged message (positive and negative) needs to be delivered.

Communication is a foundational skill in personal and professional domains. Asking the following questions can help you evaluate your current communication style and improve discussions with your remote team:

  • How developed is your team’s communication skills?
  • What areas need attention?
  • What can you accomplish through effective communication?
  • What formal and informal communication channels exist?
  • What different types of modalities do you use or consider using?

Subhead: Five virtual team basics

Supporting the remote team member or team begins with defining what overall success and wellbeing looks like for remote workers, and ensuring they feel supported within the organization. Yet, how do we become successful given the reality of distance, culture and time zones?

Following are five basic skill sets virtual teams need to ensure sustainable, engaging and effective virtual conversations:

  1. Create the context and culture.
  • Build trust and create safety; build relationships or connections.
  • Recognize opportunities for development and In a virtual world, we need to cultivate core skills to create context, communication, process, emotional intelligence, tools, group development and troubleshooting skills – not just tactical abilities.
  1. Set people up for success.
  • Focus on process and co-create expectations. Develop a clear understanding of what is expected in regard to work (i.e., hours, approaches, breaks, how to log on and share work, etc.).
  • Determine how you do things at your organization.
  • Develop clear reporting relationships, roles and responsibilities. Who do team members report to, and on what issues?
  • Determine when reporting is required.
  • Determine whether you have clarity, agreements and by/whens.
  1. Micro-moments.
  • Focus on micro-monitoring vs. micro-managing.
  • Be aware of your priorities.
  • Determine what is and is not
  • Know what support and resources are required to achieve the intended results.
  1. Community vs. island.
  • Whether we work alone or as part of a team, it takes a community to be successful in the remote space.
  • How do you support trust, create psychological safety, and connect with a team or across the organization?
  • How do team members see each other and connect with one another? (This may include regular virtual lunches, where the team connects for a meal from each of their locations; daily virtual huddles at a time that is convenient for all zones; and/or face-to-face time, either every quarter or more regularly.)
  1. Clarity on how to flag issues. Be aware of:
  • The issues to raise and when to raise them.
  • Who team members should flag issues to.
  • When team leaders are available and how can team members can reach them.
  • Available means to facilitate confidential conversations to make important decisions.

Change and disruption are a constant. Understanding virtual and remote work requires a different set of skills for different types of remote leaders and teams. This article has reviewed the basics in communication and the distinctions in a remote ecosystem, as well as five virtual team elements that provide a self-assessment for virtual and remote needs. It presents questions to support one’s call-to-actions for creating environments that engage impactful, interactive and meaningful virtual conversations. I encourage you to share this article with your colleagues, or with someone in your network, so that you can implement a new methodology in your virtual and remote workspace.

Kristine Berry is an international speaker and performance coach specializing in the areas of group coaching and team development, enhancing group practices. Looking for a speaker or coach? She invites you to contact her via email at kristine@kristineberry.com or visit her website www.kristineberry.com.


Bibliography:

Britton, Jennifer, (2017) Effective Virtual Conversations. Potential Realized Media.

Https://www.potentialsrealized.com/teams-365-blog/teams365-897-teamwork-foundations-communication. Accessed January 2020.

Https://www.potentialsrealized.com/teams-365-blog/category/virtual-facilitation. Accessed January 2020.

The OSHA inspection

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.

Complacency is unacceptable.

A surprise: Something that makes a strong impression because it is so unexpected; it can also be amazement, astonishment, shock, startlement.1 In many cases, surprises are positive events, such as a surprise birthday or anniversary party, a surprise bouquet of flowers, or a surprise visit from a dental colleague bringing treats for the office team. Other surprises may not be viewed as positive – for instance, an unexpected visit from an Occupational Safety and Health Administration (OSHA) inspector.

Section 8 of the OSHA Act addresses inspections, investigations and recordkeeping.2 It’s uncommon for OSHA to inspect a dental practice. Federal OSHA is a small agency that includes 10 regional offices and 85 local area offices; with state partners, there are approximately 2,100 inspectors responsible for the health and safety of 130 million workers employed at more than 8 million worksites around the nation. There’s roughly one compliance officer for every 59,000 workers.3 It is quite obvious that OSHA does not have the manpower to check up on every healthcare facility. Regardless, complacency and lack of adherence to set standards in any dental practice setting is unacceptable. And remember, if there is a legitimate worker complaint, an OSHA compliance officer inspector may appear at the practice.

In 2016, OSHA proposed fines of almost $54,000 to a dental practice in Illinois. Inspections stemming from a complaint alleging violations of OSHA’s bloodborne pathogen exposure standards following a worker who suffered a sharps injury. Upon inspection of the practice sites, the Chicago North area OSHA office found the employer failed to:

  • Establish a bloodborne pathogen exposure control plan and hazard communication program at either location.
  • Require the use of appropriate gloves and personal protective equipment.
  • Provide medical evaluation and follow-up to employees after an exposure incident.
  • Make the Hepatitis B vaccination series available to employees.
  • Educate workers about chemical and bloodborne pathogen hazards and train them on necessary precautions to take.4

Similarly, a complaint initiated a few years earlier led OSHA to propose fines of over $61,000 to a dental practice in Washington DC.  The cited violations included workers’ exposure to bloodborne pathogens without an exposure control plan or proper training; workers lacking proper eye protection when using chemicals to sanitize medical instruments; egress issues; exposure to electrical hazards; and the use of inadequate personal protective equipment. Additionally, the company failed to provide workers with Hepatitis B vaccinations within 10 days of employment, provide an adequate hazard communication program and training, properly label chemicals and maintain material safety data sheets for chemicals used on-site.5

In another instance, a dentist in Boston told employees to remove the protective caps of needles before disposing them into sharps disposal containers, allegedly to fill the containers with more used needles and reduce the frequency and cost of their disposal.  One of the dental assistants was concerned that she and her co-workers could be exposed to needle stick injuries and the risk of infection from bloodborne pathogens, so she raised the issue with the dentist. When he dismissed her concern, she filed a complaint with OSHA. An OSHA inspector visited the dentist, who then fired the dental assistant.  A whistleblower investigation followed and the Department of Labor sued the dentist in court, charging him with violation of the anti-retaliation provisions of OSHA. The suit eventually went to trial, where the judge ruled in favor of the department and ordered the dentist to pay the dental assistant $85,000 ($51,644.80 in back wages amd $33,450.26 in compensatory damages). The judge ruled that the dentist’s firing of the dental assistant shortly after OSHA began its inspection was both retaliatory and a violation of section 11(c) of the OSH Act.6

Regardless of practice size/setting and the type of violation, OSHA fines can be significant.  As of January 10, 2020, OSHA increased penalty fines by almost 2 percent, setting the maximum amounts as follows:

Type of Violation Penalty
Serious, other-than serious, or posting requirements $13, 494 per violation
Failure to abate $13, 494 per day beyond abatement date
Willful or repeated violation $134,937 per violation 7

The following standards, in order of frequency, were most often cited by Federal OSHA between October 2015 and September 2016:

If dental practices follow OSHA standards and the workplace is safe, it is unlikely team member employees will have anything to complain to OSHA about. In the rare case of an OSHA inspection, however, dentists should be aware of – and prepared for – the OSHA inspection process and the rights an employer, dentist or practice owner has.

OSHA inspectors – also called compliance safety and health officers – are experienced, well-trained industrial hygienists and safety professionals. They may appear at the workplace without advance notice to conduct an OSHA inspection.9 When an OSHA inspector arrives at the practice, the employer has the right to ask the inspector for credentials and inquire as to the basis for the inspection before agreeing to allow it to proceed.9,10  If it involves an employee complaint, the employer is entitled to receive a copy of the written complaint (without the name of the complaining employee), as well as information on the specific programmed inspection that the inspector is relying upon.10

Under the Fourth Amendment, employers are free from unreasonable searches and seizures, which includes inspections by OSHA. In other words, OSHA may not inspect a workplace unless the Agency has administrative probable cause to believe that a violative condition exists. Accordingly, employers have a right to demand an inspection warrant that establishes OSHA’s probable cause to inspect; but in most cases, cooperation and allowing an inspection to take place on a voluntary basis is a more productive option.11 

The first step in the inspection process is an opening conference. The inspector explains why OSHA has selected the practice for inspection, and describes the scope of the inspection, walkaround procedures, employee representation and employee interviews. The employer/dentist should select a representative to accompany the inspector during the inspection.9,10 If the representative is not onsite, the inspector is required to wait a “reasonable time period” before commencing the inspection. An authorized representative of the employees, such as a practice manager or compliance officer, also has the right to accompany an inspector. And the inspector has the freedom to speak privately and question a reasonable number of employees during the inspection.10

The walkaround is the next step. Following the opening conference, the inspector and the representatives will walk through the areas of the practice covered by the inspection, assessing for hazards that could lead to employee injury or illness.9  The inspector should not be allowed free reign of the dental practice; rather, the inspection should be contained to areas related to the complaint or safety issue presented.10 At this time, the inspector reviews worksite injury and illness records, as well as the posting of the official OSHA poster, making a case for dental practices to maintain accurate and current records at all times. During the walkaround, inspectors may point out some apparent violations that can be corrected immediately. While the law requires these hazards must still be cited, prompt correction is a sign of good faith on the part of the employer.

The final step is the closing conference. After the walkaround, the inspector holds a meeting with the employer/dentist and the employee representatives to discuss the findings. The inspector discusses possible courses of action an employer may take following an inspection, which could include an informal conference with OSHA or contesting citations and proposed penalties. The inspector also discusses consultation services and employee rights.9

When an inspector finds violations of OSHA standards or serious hazards in the dental practice, as a regulatory agency, OSHA may issue citations and fines. Citations describe OSHA requirements allegedly violated, list any proposed penalties and give a deadline for correcting the alleged hazards. When settling a penalty, OSHA’s policy is to reduce penalties for small employers and those acting in good faith. However, no good faith adjustment is made for alleged willful violations.9

Although it may be unlikely that an OSHA inspection will take place in your dental practice setting, why risk it? The stakes are quite high for a negative impact on the practice if there are known OSHA issues, citations and fines. The practice can be deemed an unsafe workplace and seen as careless; general reputations are at risk. Dental practices must always follow OSHA standards and best practices to ensure team – as well as patient – safety. Doing the right thing will not only lessen the stress of an unexpected OSHA visit, it’s the right thing to do!

References

  1. Miriam Webster. Available at https://www.merriam-webster.com/thesaurus/surprise. Accessed January 22, 2020.
  2. U.S. Department of Labor. Occupational Safety and Health Administration. Section 8. Available at https://www.osha.gov/laws-regs/oshact/section_8. Accessed January 22, 2020.
  3. U.S. Department of Labor. Occupational Safety and Health Administration. Commonly used statistics. Available at https://www.osha.gov/data/commonstats. Accessed January 22, 2020.
  4. U.S. Department of Labor. Occupational Safety and Health Administration. OSHA News Release – Region 5. Available at https://www.osha.gov/news/newsreleases/region5/07052016. Accessed January 22, 2020.
  5. U.S. Department of Labor. Occupational Safety and Health Administration. OSHA News Release – Region 3. Available at https://www.osha.gov/news/newsreleases/region3/07162013. Accessed January 22, 2020.
  6. U.S. Department of Labor. Occupational Safety and Health Administration. OSHA News Release – Region 1. Available at https://www.osha.gov/news/newsreleases/region1/04082015. Accessed January 23, 2020.
  7. U.S. Department of Labor. Occupational Safety and Health Administration. OSHA Penalties. Available at https://www.osha.gov/penalties. Accessed January 22, 2020.
  8. U.S. Department of Labor. Occupational Safety and Health Administration. Dentistry. Available at https://www.osha.gov/SLTC/dentistry/standards.html. Accessed January 23, 2020.
  9. U.S. Department of Labor. Occupational Safety and Health Administration. OSHA Fact Sheet; OSHA Inspections. Available at https://www.osha.gov/OshDoc/data_General_Facts/factsheet-inspections.pdf. Accessed January 23, 2020.
  10. Lies, M. EHS Today. OSHA Inspections: What to Expect as an Employer. January 1, 2009. Available at https://www.ehstoday.com/standards/osha/article/21912000/osha-inspections-what-to-expect-as-an-employer. Accessed January 23, 2020.
  11. Epstein, Becker, Green. OSHA Law Update. What Are Employers’ Rights During OSHA Inspections? Available at https://www.oshalawupdate.com/2013/10/10/what-are-employers-rights-during-osha-inspections/. Accessed January 23, 2020.

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.

Surface disinfectants

As products become more diverse, dental practices must find solutions that fit their needs.

Surface disinfectants today offer kill claims and product features unmatched by their earlier counterparts. Contrary to what some dental professionals might believe, however, not all surface disinfectants are alike. “Each surface disinfectant possesses its own set of characteristics and attributes associated with its formulation,” says Joel Rich, national sales director of non-acute, GOJO Industries, Inc. Such features as timing, aesthetics and compatibility all contribute to the overall success and the breadth of use of a surface disinfectant. And, products may differ in their versatility and safety, making it especially important for each dental office to purchase solutions that meet their specific needs.

Taking steps to prevent the spread of infection at the dental practice, while not difficult, does require time, effort and mindfulness. And, unless regularly disinfected to remove germs and bloodborne pathogens, some surfaces – particularly those that are frequently touched or contacted – present a risk of contamination. The good news is that surface disinfectant manufacturers have begun collaborating with other device and product companies, leaving dental professionals with an increasing number of options for preventing the spread of infection at their practice.

“The versatility of surface disinfectants has increased, enhancing product compatibility and permitting use throughout a facility,” says Rich. “As surface disinfectant manufacturers collaborate with other device and product manufacturers, a synergistic effect has taken hold, leading to new and easier-to-use disinfectants.”

Surface disinfectants today can be used on a wide variety of surfaces, devices and instruments, Rich continues. “Surface disinfectant sprays are often appropriate for both hard and soft surfaces, allowing for much more versatility of use.” By comparison, surface wipes – while also effective – are generally reserved for hard, non-porous surfaces, reducing some of the areas where it can be utilized, he adds. “Wipes and sprays both offer a consistent broad spectrum of coverage, however soft surfaces generally are not approved for wipes, whereas most sprays offer flexibility for both hard and soft surfaces.”

GOJO Industries, Inc. recently introduced PURELL Surface Disinfectant, a broad-spectrum, one-step surface disinfectant and cleaner that features rapid kill and dry times with no glove or rinse requirements on the label, according to Rich. However, proper facility-established protocols should be followed, he adds. It is said to offer 30-second disinfection for MRSA, VRE and Norovirus, and be effective on most hard and soft surfaces, from plastics and porcelain to metals, laminate, granite, upholstery, sealed wood, vinyl and more. In addition, it has the lowest possible EPA ratings, and as such, carries no precautionary statements or warnings, he points out.

“The Centers for Disease Control and Infection (CDC) guidelines encourage the proper cleaning and disinfection between patient use of shared medical devices and patient-centric areas,” says Rich. Today’s surface disinfectants make it easier for the dental staff to do so, he adds.


Safety and toxicity

Dental professionals looking to purchase a new surface disinfectant will likely have a few considerations: How safe is a disinfectant? How likely is it to corrode or damage certain surfaces? How toxic is the surface disinfectant? How likely is it to penetrate gloves and/or irritate skin?

The EPA utilizes four categories of classification to determine safety and toxicity:

  • Toxicity category I is highly toxic and severely irritating.
  • Toxicity category II is moderately toxic and irritating.
  • Toxicity category III is slightly toxic and irritating.
  • Toxicity category IV is practically non-toxic and not an irritant.

These toxicity categories play an integral role in product selection, when it comes to consideration of gloving, personal protective equipment, equipment compatibility and overall aesthetics.

Source: GOJO Industries, Inc.

Editor’s note: PURELL Surface Disinfectant spray is a category IV product.

Facemasks

Selecting comfortable, great-fitting masks for the dental team can be key in ensuring that they consistently wear them.

If you believe dentistry to be a low-risk career, think again. According to a 2018 post by Business Insider, of the top five professions considered most damaging to one’s health, four are in dentistry, including that of dental hygienist and general dentist.

Indeed, when dental professionals neglect to take necessary precautions, they place themselves in harm’s way. For starters, most procedures performed by dental clinicians using ultrasonic scalers, high speed handpieces and air-water syringes are capable of generating contaminated aerosols and splatter, according to Monica Cardona, product manager, personal protective equipment, Crosstex International Inc., a Cantel Medical Company. In fact, the ultrasonic scaler produces more airborne contamination than any other dynamic instrument in dentistry,1 she points out. Furthermore, dental aerosols can travel up to four feet from the work zone2 and remain airborne for up to 30 minutes, placing the dental team at risk for the transmission of infection.3

Some dental professionals may not be aware of the various risks airborne contamination poses to their team, says Cardona, who notes the following:

  • There is an increased prevalence of respiratory infections among dentists, and the symptoms are associated with the highly contaminated breathing zone in the dental operatory.2
  • Based on the average rate of respiration at 16 breaths per minute, a clinician has the potential for 7,680 exposures in a workday.4
  • With laser dentistry on the rise, dental professionals are facing a new set of occupational health risks – the potential transmission of disease through the laser plume.5
  • 95% of laser plume is made up of water, but the remaining 5% contains potentially hazardous bioaerosols, including cellular debris, blood fragments and bacteria.5

“The most effective means to reduce transmission of pathogenic organisms is the use of personal protection equipment (PPE) such as gloves, masks, and eye protection,” says Cardona. “The better educated dental professionals are, the more likely they will be to comply with accepted standards and guidelines,” she adds.

Selecting the right face mask

Selecting comfortable, great-fitting masks for the dental team can be key in ensuring that they consistently wear them. In addition, it’s important to understand mask ratings in order to choose the appropriate mask protection level for each procedure performed at the practice. Several mask designs are considered to provide exceptional comfort, according to Cardona:

  • The Ultra Sensitive Earloop Mask with Secure Fit Technology from Crosstex, with an extra soft, white hypoallergenic, inner cellulose layer, will not lint, tear or shred, providing ultimate comfort.
  • Masks with flat ear loops attached to the outside of the mask (as opposed to the inside of the mask) provide a comfortable fit and help eliminate irritation.
  • Masks free of latex, fiberglass, chemicals, inks and dyes help minimize skin sensitivities.
  • Masks with anti-fog or fog-free strips on the inner layer block and absorb moisture. They also form a strong seal, preventing the fogging of eyewear while it cushions the nose ridge.
  • Some masks have unique vapor barriers on the outside layer, further blocking moisture.

Cardona recommends using the following charts to determine the most appropriate mask rating levels for different procedures:

Face Mask Tests and User Benefits
Tests Test Description User Benefits
Fluid Resistance (mm Hg) The ability of a face mask’s materials of construction to minimize fluids from traveling through the material and potentially coming into contact with the wearer. Face masks are tested with synthetic blood on a pass/fail basis at three velocities corresponding to the range of human blood pressure (80, 120, 160 mm Hg). The higher the pressure withstood, the greater the fluid spray and splash resistance. Helps reduce potential exposure of the wearer to splash and splatter of blood, body fluids and other potentially infectious materials (OPIM).
Bacterial Filtration Efficiency

(BFE percent) @ 3.0 µm

BFE is the measure of the percent efficiency at which a face mask filters bacteria passing through the mask by comparing the bacterial inlet concentration to mask effluent concentration. A higher percentage indicates higher filtration efficiency (i.e., a 95% filter efficiency indicates that 95% of the aerosolized bacteria was retained by the mask and 5% passed through the mask material. Helps reduce wearer exposure to microorganisms.
Particulate Filtration Efficiency

(PFE percent) @ 0.1 µm

PFE is the measure of the percent efficiency at which a face mask filters particulate matter passing through the mask by comparing the particulate inlet concentration to mask effluent concentration. Helps reduce wearer exposure to airborne biological particles, inorganic dust and debris.
Differential Pressure

(ΔP mm H2O/cm2)

Measures the resistance of mask materials to airflow, which relates to the breathability of the mask. The values are expressed from 1 to 5; the higher the number, the higher the PFE and BFE. Provides measure of comfort and breathability.
Flammability

(flame spread)

The rate at which the material burns determines the level of flammability; a minimum of a 3.5 second burn rate is required to pass with a Class 1 rating. Mask materials are flame spread Class 1 rated, meeting FDA recommendations for materials of construction of surgical masks intended for use in operating rooms.

Source: ASTM International (formerly known as American Society for Testing and Materials).

Face Mask Material Requirements by ASTM Performance Level
 Characteristic LEVEL 1 LEVEL 2 LEVEL 3
Fluid Resistance (mm Hg) 80 120 160
Bacterial Filtration Efficiency (BFE percent) @ 3.0 µm ≥ 95% ≥ 98% ≥ 98%
Particulate Filtration Efficiency (PFE percent) @ 0.1 µm ≥ 95% ≥ 98% ≥ 98%
Differential Pressure

(ΔP breathability)                           (mm H2O/cm2)

< 4.0 < 5.0 < 5.0
Flammability (flame spread) Class 1 Class 1 Class 1

Source: ASTM International (formerly known as American Society for Testing and Materials).

ASTM Level 1 ASTM Level 2 ASTM Level 3
Ideal for procedures where low amounts of fluid, spray and/or aerosols are produced. Ideal for procedures where light-to-moderate amounts of fluid, spray and/or aerosols are produced. Ideal for procedures where moderate-to-heavy amounts of fluid, spray and/or aerosols are produced.
• Patient exams • Limited oral surgery • Complex oral surgery
• Operatory cleaning/maintenance • Endodontics • Crown preparation
• Impressions • Prophylaxis • Implant placement
• Lab trimming, finishing & polishing • Restoratives/ composites • Periodontal surgery
• Orthodontics • Sealants • Use of ultrasonic scalers (Magnetostrictive and Piezo)
• Laser-based applications*

*Masks are considered a secondary control and are not meant to replace recommended primary engineering controls for laser plume exposure.

Source: ASTM International (formerly known as American Society for Testing and Materials).

ASTM International is an international standards organization, as well as a globally recognized leader in the development, product testing and delivery of international voluntary consensus standards. The latest version of the standard specifying performance of face masks, ASTM F2100-11, was released in April 2011. Face mask material performance is based on testing for fluid resistance, bacterial filtration efficiency (BFE), particulate filtration efficiency (PFE), breathability (Δ P) and flammability.

Stay ahead of the game

Not only must different face masks be worn for different procedures, they must be a good fit for the wearer. Contaminants can bypass a mask in several ways; a well-fitting mask that can conform to any face shape or size can greatly reduce the risk of infection. Masks with malleable nose and chin closures allow for a customized fit, increasing the effectiveness of mask protection. Furthermore, guidelines state a mask must be changed with each patient. It’s also recommended that clinicians change their mask every 20 minutes in a moderate-to-high aerosol environment and every hour in a non-aerosol environment. It’s important to note that the filter media of a mask becomes less effective when wet.

And, the best time to determine whether anyone at the practice has skin sensitivities is before new masks as purchased. Colors and inks made from chemicals and dyes are common irritants to the skin. If the inside of the mask is colored or has a print, this may be the cause of irritation. And while a white mask interior is ideal, not all white mask interiors are the same. A white cellulose interior is recommended for sensitive skin. Ideally, masks free of latex, fiberglass, chemicals, inks and dyes should be worn to minimize potential skin sensitivities.

References

  1. Chugh, A. “Occupational Hazards in Prosthetic Dentistry.” Dentistry 07, no. 02 (2017).
  2. Veena, et al. “Dissemination of Aerosol and Splatter during Ultrasonic Scaling: A Pilot Study.” Journal of Infection and Public Health 8, no. 3 (2015): 260-65.
  3. Harrel, S. “Contaminated Dental Aerosols: Risks and Implications for Dental Hygienists”. Dimensions of Dental Hygiene. October 2003;1(6):16, 18, 20.
  4. Johns Hopkins Medicine; Health Library. Vital Signs, accessed December 29, 2014.  http://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases/vital_signs_body_temperature_pulse_rate_respiration_rate_blood_pressure_85,P00866/
  5. Ulmer B C. “The hazards of surgical smoke.” AORN J. April 2008; 87(4):721-734.

Secure Fit Mask Technology

Crosstex masks with Secure Fit Mask Technology feature flexible aluminum strips above the nose and below the chin, creating additional breathing space and allowing for a custom fit, regardless of face shape or size. This innovative design significantly reduces gapping at top, bottom and sides, increasing the effectiveness of mask protection. Even if a mask has a high-level filter, the lack of a close circumferential seal to the face will negate filter performance, because particles will follow the path of least resistance and travel through the gaps between the mask and the face. Most regulatory and professional organizations recognize the inherent fit issues of masks showing gaps along the cheeks and chin. A recent study evaluating the total leakage through a surgical face mask indicated five to eight percent came from filter leakage, with 25-38 percent coming from face seal leakage.1

Source: Crosstex International Inc., a Cantel Medical Company.

Reference

1Grinshpun, S. A., Haruta, H., Eninger, R. M., Reponen, T., McKay, R. T., and Lee, S.-A. (2009). Performance of an N95 Filtering Facepiece Particulate Respirator and a Surgical Mask During Human Breathing: Two Pathways for Particle Penetration. J. Occup. Environ. Hyg., 6:593–603.

No one-fits-all solution

Gloves today are thinner – and offer greater durability – than their predecessors.

When selecting the best glove solutions for a dental practice, a lot depends on personal preference. Factors such as flexibility, tactile sensitivity, cost and the potential for allergic reactions to certain glove materials all come into play. “There is no one glove that fits all,” says Alen Kwong, Business Development, Cranberry®. “However, all gloves should provide the comfort and protection that allow dental professionals to work safely in their environment.”

The good news is that many gloves today – whether latex, nitrile or another material – are thinner, facilitating greater tactile sensitivity, yet more durable than in years past.

Know your options

There are pros and cons to every glove type, notes Kwong.

  • Latex. Latex gloves have long been considered a trusted glove material for dental markets. Made from natural rubber latex, these gloves are known for their flexibility and fitment properties, as well as their ability to offer reliable barrier protection. That said, some practitioners and patients have allergic reactions to latex gloves, widely deterring their use.
  • Vinyl. A more economical option than latex, vinyl gloves are made with polyvinyl chloride and are free of latex allergens. Glove wearers, however, often feel vinyl gloves do not offer the same flexibility as latex gloves.
  • Made with synthetic rubber, nitrile gloves offer nearly the same flexibility and durability that latex gloves provide. Not long ago, some doctors considered nitrile gloves too expensive to purchase. However, newer generations of nitrile gloves have come down in price, and today they are thinner than latex gloves, while retaining their durability. That said, there have been growing concerns over allergic reactions to the chemical accelerators used in nitrile glove manufacturing. As a result, new accelerator-free nitrile gloves are becoming more popular.
  • Polychloroprene. Due to the growing concerns over allergic reactions to the chemical accelerators used in nitrile glove manufacturing, accelerator-free nitrile gloves – or polychloroprene gloves – have become more and more popular. Not only are polychloroprene gloves not associated with allergies, their synthetic rubber content is said to closely match the flexibility and barrier protection offered by latex gloves.

“Some dental professionals may find it confusing that different gloves are packaged in different quantities, ranging from 100 to 300 gloves per box,” says Kwong. That said, it’s possible to calculate a standard unit of cost across the board. While it’s important to make economical choices, however, it never pays to save money at the expense of staff and patient safety.”


Never settle with your hands: Inspire Nitrile

Don’t settle for just any glove. Cranberry offers a full range of nitrile gloves, including their newest offering: Inspire. Dental professionals will appreciate the great fit and comfort Inspire gloves offer. Weighing only 2.5 grams, Inspire is the lightest nitrile glove available for dental professionals, and features less constraint, more control and greater tactile sensitivity. The glove’s light weight facilitates enhanced fingertip texture, extension and flexion throughout the clinical procedure, while the InSoft formulation minimizes hand fatigue and provides superior grip for increased comfort and better performance.

Source: Cranberry