Going for the Gold

CBCT continues to change the dental landscape

The last 20 years have seen major strides in dental technology, perhaps the most significant of which was the introduction of cone beam computed technology (CBCT) in the United States. As far as some doctors are concerned, the possibilities CBCT has opened continue to expand. Today, the technology is credited with having led to greater diagnostic accuracy, more precise implant placement, reduced chair times for patients and more.

Efficiency in Group Practice reached out to a few doctors about the impact of CBCT and their ability to provide the best possible patient care. Here is what they have to say.

Heidi Kohltfarber, DDS, MS, PhD, oral and maxillofacial radiology, diplomate of the ABOMR, adjunct assistant professor, UNC-Chapel Hill, founder, Dental Radiology Diagnostics, consultant for Dentsply Sirona.

Thanks to CBCT, patients today spend less time in the dental chair, according to Heidi Kohltfarber, DDS, MS, PhD. Doctors can better educate their patients, creating a stronger doctor-patient bond and facilitating greater case acceptance. Not only are patients more involved and proactive in their overall healthcare, they can benefit from more accurate and innovative treatment options than ever before, she adds.

“CBCT was introduced into the dental field due to the need for low cost, low dose three-dimensional images for implant treatment planning purposes,” says Kohltfarber. “Clinicians were eager to improve the accuracy of implant placement and there was an obvious need to clearly visualize pertinent anatomy.

“The technology is based on a cone beam in which a dental X-ray source and reciprocating detector move in synchrony around the patient in a single rotation,” she explains. “It delivers multiple high-resolution, multiplanar, reconstructed images, which provide a geometrically accurate representation of the patient’s anatomy in the axial, sagittal and coronal sections with a 1:1 measurement ratio of objects within the volumetric images.

“Cone beam CT was invented from a combination of three different technologies,” says Kohltfarber. “The original image intensifiers are similar to those used in cardiac imaging with fluoroscopy. It employs an algorithm used for medical CT and is usually constructed and designed on a unit that is structurally similar in appearance and size to a dental panoramic X-ray machine. As such, it will fit into a dental office.”

Efficiency in Group Practice: How has CBCT led to greater efficiency?

Heidi Kohltfarber, DDS, MS, PhD, oral and maxillofacial radiology: Cone beam CT is an excellent modality, which has led to greater diagnostic accuracy, become a foundation for digital dentistry, and enhanced patient education. For example:

  • CBCT images can be used to produce surgical guides that are based on a clinician’s implant treatment plan. This has helped to decrease chair time during implant surgery, as well as decrease the chance of post-operative complications.
  • It has multiple applications beyond implant dentistry, such as endodontics, periodontics, orthodontics, prosthodontics and craniofacial surgery.
  • It has improved efficiency by allowing clinicians to visualize the dentition without the impediment of superimposition of structures, enabling them to diagnose in multiple areas more effectively and efficiently (such as apical pathologies, periodontal bone loss, position and orientation of the teeth, visualization of the airway space and temporomandibular joints, as well as give a more accurate estimation of tooth prognosis.)
  • Cone beam CT volumes provide clinicians with the ability to enhance patient care through surgical simulations that improve surgical treatment planning, surgical predications, fabrication of surgical stents and post-surgical follow-up. In fact, a very exciting and emerging area is the use of cone beam CT volumes to develop 3D models, as well as 3D printed appliances and surgical guides.

Efficiency in Group Practice: How has CBCT impacted the role of dental professionals?

Kohltfarber: With CBCT, the entire dental team can be better involved in patients’ health and welfare.

  • Dentists can diagnose patient problems more efficiently and accurately. They can provide more accurate implant placement, more accurate surgical and orthodontic results, and place same-day crowns.
  • Dentists can diagnose limited airway spaces, which may cause obstructive sleep apnea; observe and appropriately refer patients to their medical colleagues for vascular calcifications that may put patients at an increased risk for stroke; and visualize various pathologies while they are still treatable.
  • Dental hygienists can more accurately visualize periodontal bone levels, areas of bone loss and radiographic calculus. Dental assistants can take diagnostic images much more quickly than traditional full-mouth series.
  • Office managers can provide more efficient schedules to help improve overall patient care and satisfaction.

Efficiency in Group Practice: When is it more appropriate for dentists to use two-dimensional radiographs?

Kohltfarber: Cone beam CT is not a great imaging modality for caries diagnosis. Imaging artifacts around metallic restorations can lead to increased false positives. Therefore, traditional 2D radiographs, such as intraoral bitewings, should still be employed for the task of caries diagnosis. However, there is exciting research in the area of digital tomosynthesis currently being conducted at UNC-Chapel Hill, which may soon change the way that we view traditional bitewing radiographs.

Efficiency in Group Practice: How will dental radiology continue to evolve?

Kohltfarber: The industry continues to research three-dimensional imaging and hopes to develop new technologies that will help make dentists more productive and efficient, as well as provide patients with more options for better dental care. CBCT has given scientists the ability to observe a particular anatomic region with an accurate 3D representation, which can be segmented into a 3D model, rotated and overlaid with the same object from another time period. As such, they can easily evaluate everything from orthognathic surgery cases to orthodontic treatment, periodontal bone loss, osteoarthritic changes, limited airways and craniofacial surgery cases over time. In addition, based on three-dimensional, segmented models, scientist have been able to 3D print bony scaffolds, infuse them with stem cells and regrow various anatomical regions, such as mandibular condyles. The ability to replace a diseased area with one that is anatomically correct for the patient could be phenomenal. Other imaging modalities, such as digital tomosynthesis, ultrasound and magnetic resonance imaging, are also being evaluated for their accuracy and efficacy in the field of dentistry. Digital dentistry is just the tip of the iceberg.

Keith R. VanBenthuysen, DMD, FAGD, a Nashville, Tennessee-based practice owner and a consultant for Marquee Dental Partners.

Digital radiography has dramatically changed the dental landscape, says Keith R. VanBenthuysen, DMD, FAGD. But cone beam computed tomography has advanced the industry even further. “With digital radiography, we are able to share images in real-time online with our colleagues, he points out. “CBCT has taken the industry beyond that, advancing our ability to see the anatomy. It has become an invaluable tool to support dental diagnostics.” In fact, many industry experts believe CBCT has emerged as the gold standard for imaging in the oral maxillofacial area, he adds.

Efficiency in Group Practice: How has CBCT led to greater efficiency?

Keith R. VanBenthuysen, DMD, FAGD: A patient’s visit to a dental office looks vastly different today versus five years ago. Thanks to CEREC and related technologies, patients are finding their crowns can be completed in one appointment, rather than having to live with a temporary crown for two or three weeks. With CBCT, patients can get a proper diagnosis at the first appointment instead of making multiple visits while we watch their tooth, waiting for the symptoms to worsen.

Efficiency in Group Practice: How has CBCT impacted the role of dental professionals?

VanBenthuysen: It has done so in many ways:

  • Endodontists are better able to diagnose cracked teeth and vertical root fractures. They are in a better position to determine whether or not the tooth is restorable. Additionally, CBCTs can assist in determining the number, shape and position of the canals.
  • Oral surgeons can better evaluate the anatomy surrounding third molars, perhaps avoiding injury to the IAN. They can look at potential implant sites and pre-plan implant surgeries. In conjunction with CEREC technologies and CBCT, surgeons can create surgical guides with extreme accuracy, thereby avoiding many of the previous pitfalls associated with implant surgery. Procedures can be streamlined and performed in a more timely manner.
  • CBCT has provided better diagnostic imaging for doctors and hygienists, improved efficiency for dental assistants and has enabled office managers to communicate treatment recommendations more clearly with insurance companies.

Efficiency in Group Practice: When is it more appropriate for dentists to use two-dimensional radiographs?

VanBenthuysen: According to the FDA, total radiation doses from 3D CBCT exams are 96 percent lower than conventional CT exams; however they deliver more radiation than standard 2D radiography. It is my opinion that CBCT should be reserved for use where 2D radiographs and other diagnostic tools prevent doctors from making an accurate diagnosis. 2D X-rays may be more appropriate for the diagnosis of caries, periodontal disease and most endodontic cases.

Efficiency in Group Practice: How will dental radiology continue to evolve?

VanBenthuysen: It is my absolute belief that CBCT will improve our visualization of the oral and maxillofacial complex. In the future, I expect radiation exposure will be reduced and the images will further improve. We will be even better able to combine CBCT with other technologies to enhance our treatment capabilities and outcomes. CBCT, digital radiographs and intraoral scanners will continue to revolutionize the practice of dentistry by maximizing economy and accuracy, minimizing chair time and reducing patient visits.

CBCT continues to advance dental industry

Over the past number of years cone beam computed technology (CBCT) has decreased in price, making it increasingly prevalent, according to Eric Tobler, DMD, regional president, Stonehaven Dental, part of Mortenson Dental Partners. In addition, the dosage of radiation had decreased significantly, he points out.

“In our practice CBCT is regularly referenced for review of impacted teeth, analysis of bone in edentulous areas and for endodontic diagnosis,” says Tobler. “This is especially true for the diagnosis of maxillary molars, where CBCT may detect abscesses near the sinus or the presence of MB2, which may be difficult or impossible to detect with 2D radiographs. CBCT can also be useful for organic orthodontic treatment, airway studies and the diagnosis of sinus conditions.” All that said, 2D digital radiographs continue to be the preferred method for routine examinations and diagnosis of dental decay, he adds.

Nov/Dec 2018


Click Here to Read the current issue
(w link to PDF download)

Making the Connection
Patients today respond to digital marketing.

A Tale of Two Brands

Editor’s Note
Finding their Voice

Addressing Workplace Bullying
Bullying in the dental office can take an emotional and financial toll on the practice.

Be the Leader They Want

One Message, Many Audiences
Maintaining a consistent brand across a large organization isn’t easy, particularly when the target audience is so diverse

Periodontal Disease
Understanding the risks of periodontal disease can motivate patients to adhere to a good oral homecare routine.

A novel solution
SDI’s Riva Star is a two-step process silver diamine fluoride (SDF) and potassium iodide (KI) desensitizer.

Cutting-edge technology has facilitated more accurate diagnosis and treatment.

Special Markets Solutions: Look, Listen, Learn

The Dental/Medical Clinic
As the two disciplines draw closer together, is the dental/medical clinic far behind?

Needlestick and Sharps Injuries
Dentistry may not be as dangerous as skyscraper construction or racecar driving, but it has its share of risks

OSAP Dental Infection Control Boot Camp ™

OMNICHROMA: One shade fits all

Industry News

Advanced Software Modules and Applications Lead to More Dedicated Patient Care

Sponsored: Carestream Dental

How can doctors in group practices provide the same dedicated care and attention to each and every patient? The skill and patience of the doctor are crucial, of course, supported by a confident analysis, efficient treatment planning and patient buy-in. However, the busy nature of group practice presents a challenge to giving each case the consideration it deserves. That’s where advanced software modules can become a powerful tool.

Confident Analysis
Dental software modules are designed to give users more confidence in their work. Automation, color-coding, easy-to-generate reports, visualization tools and simple customization options are all features that assure doctors of more predictable results when analyzing the best path forward.

Efficient Treatment Planning
Software modules that digitally automate what is typically a manual process can save valuable time for clinicians. Additionally, software that’s intuitive, easy-to-learn and requires only a few clicks to use means doctors can go from treatment planning to treatment presentation faster.

Better Patient Communication
Powerful visualization tools are an advantage to case acceptance. Simulations of treatment or easy-to-understand color-coding help patients understand their options and give them peace of mind when accepting treatment.

Carestream Dental Solutions
A few things are for certain—to manage workflow and coordinate patient care efficiently, software modules must be intuitive, easy to use and compatible with existing applications and equipment. Fortunately, Carestream Dental prides itself on workflow integration, meaning its software is designed to integrate seamlessly with existing Carestream Dental hardware.

CS Model+
CS Model+ has redefined the orthodontic workflow by completely automating the segmentation, setup and analysis process for digital models. Once the model is setup, CS Model+ lets doctors examine different potential treatment approaches and also assess a case’s level of difficulty from a wide range of common industry standards.

Easy-to-generate reports and visually rich simulations of treatment options are helpful when relaying treatment options to patients and referrals. The CS 9300, CS 8100 3D and CS 8100SC 3D imaging systems or the CS 3600 intraoral scanner can be used to acquire digital models for analysis by the CS Model+ module.

CS Airway
The CS Airway module allows doctors to easily trace and analyze patient’s airway in 3D. The airway can be segmented in as few as two clicks and the software automatically calculates total volume, minimum cross-sectional area, minimum Anterior-Posterior and Left-Right measurements. Clinicians can visualize airway passage constriction thanks to a color-coded 3D view of the pharyngeal region; this color-coding also helps them communicate conditions and treat- ment plan to patients. CS Airway is compatible with the CS 9300 and CS 9300.

Adding software modules to the workflow of a group practice gives doctors the ability to review every patient’s case with the highest level of attention to detail.

To learn more about Carestream Dental’s portfolio of imaging technology and software modules, please call 800.944.6365 or visit carestreamdental.com today.

Deming’s Diagram

Dr. Sami Bahri, DDS. Dr. Sami Bahri is the author of “Follow the Learner: The Role of a Leader in Creating a Lean Culture,” and of the DVD “Single Patient Flow: Applying Lean Principles to Heathcare”. The book won the 2010 Shingo Prize for Research and Professional Publication and the video won the same award for 2013. The Shingo Prize Conference also recognized Bahri as the “World’s First Lean Dentist.” He is a soughtafter speaker and lecturer nationally and internationally on implementing Lean management in dentistry. Dr. Bahri can be reached at Sami@bahridental.com

By Sami Bahri

How one diagram can improve productivity beyond your expectations

“Information, no matter how complete or speedy, is not knowledge. Knowledge has temporal spread. Knowledge comes from theory. Without theory, there is no way to use the information that comes to us on the instant.” Those are the words of management guru W. Edwards Deming in his book, The New Economics: For Industry, Government, Education.

The theory Deming invented is called Total Quality Management (TQM) — later, it evolved into six sigma. In the evolution of management knowledge, TQM evolved in the same period as the Lean Management Theory created by Toyota; and the two theories seem to be influenced by each other.

Going back to the above mentioned quote, Deming clearly wanted to seek knowledge, not just information. Unfortunately, still to this day, we practice in dentistry many beliefs that he considered as merely information, not knowledge.

For example, Deming wrote against setting numerical goals. As a statistician and a system’s thinker, he knew that a process is always capable to produce a certain amount of work, which means that it will necessarily produce a certain amount of waste. To him, setting numerical goals that fall beyond to process capability is irrelevant. What is relevant is to increase the capability of a process by improving its design. To that end, Deming thinks that the only way is to follow a theory of process improvement. In my own experience, Lean is the best theory today. However, it can become richer if we combine it with Deming’s 14 principles of management.

Here is another practice that Deming admonished. How many times have you heard a manager say that if you can’t measure it you can’t manage it? Although a statistician is supposed to put a great deal of importance on numbers, Deming preferred a theory for improvement over measurements and numerical information as he wrote: “It is wrong to suppose that if you can’t measure it you can’t manage it — a costly myth.”

What did Deming recommend?
Deming did not stop at saying what not to do. He actually gave precious advice on what to do.

In his seminal book Out of the Crisis, he wrote that quality comes first, and when you improve it, you unleash a chain reaction. “Improve quality and costs decrease because of less rework, fewer mistakes, fewer delays, snags/ better use of machine-time and materials. This leads to improved productivity, allowing you to capture the market with better quality and lower price, which in turn allows you to stay in business and provide jobs.”

The Deming Diagram
When he went to Japan to help in the rebuilding of the Japanese industrial production, Deming shared the following diagram as a basis for efficient productivity. According to him, this diagram was “… taught to hundreds of engineers, [it] commenced the transformation of Japanese industry. A new economic age had begun.” I hope that sharing it with you will commence a new economic age for dentistry.

This diagram views production as a system. Improving quality envelopes the entire production line. In our case, the production line translates into the entire chain of events that lead to the patient treatment; from the first call, to the exam and treatment planning, all the way until the mouth is totally healthy. As in lean management, Deming sees flow as the foundation of productivity;

From a flow point of view, every activity, and every job, is a part of a process.

Flow diagrams are important tools to understand and improve productivity. To draw a flow diagram of any process, we will have to divide the work into steps. The steps should not be viewed as individual entities, each running at maximum profit, but as a connected whole, forming the process.

Work comes into any step, changes state, and moves on into the next step. In other words, at every step there will be production (seen as a change of state), input changes to output, something happens to materials, papers, information or the patient that come into any step; and they go out in a different state. Then they move to the next step that in production terms, is the client of the previous step.

As such, the efficiency of every step in the process becomes totally dependent on the quality of the work passed on by the previous step. Which makes each step responsible for two important aspects of production:

  1. It needs to execute the work perfectly as agreed upon by the team, and pass on only good work to the next step.
  2. Check the quality of its own work as experienced by the next step. With this constant feedback, the previous step is responsible for continuously improving the quality of its work, aiming at better and better satisfaction of its customer, the next step. That is when the concept of continuous improvement becomes crucial

The Deming/Shewhart Cycle
Continuous improvement is a fact of life, otherwise, we would still be living like the Stone Age. Lean management took the idea from Deming, and his teacher, Walter A. Shewhart, and systematized it. It became part of a relentless pursuit for improving every aspect of production by everyone, everywhere in the practice, at all times.

Deming presented the following diagram to guide us through the efforts of continuous improvement; it is called the PDCA (Plan, Do, Check, Act) cycle. It is called a cycle, because it was conceived to be repeated indefinitely. We can never reach perfection and because every time we find an improvement idea, it can last until the environment changes. Technology changes, dental science changes, employees come and go; change is inevitable and the PDCA cycle helps us deal with it.

In conclusion, according to Deming, we need to follow a management theory if we intend to move our practices to the next level. The latest and most advanced theory in my judgement is Lean management. I hope to see dentistry move into the new era, the era of lean dental management that allows patients, practices and everyone who deals with them, to benefit. At the same time, I find the management principles that Deming taught to be timeless and invaluable. I strongly encourage you to learn them, the resources are readily available and abundant. Finally, continuous improvement is the way to apply those theories. If you have any questions, email me at sami@bahridental.com.

Creating Memorable Patient Experiences

A well-functioning dental team puts patients at ease

Knowing how to have fun is key to building a
strong dental team. Kimberly Kelly, area business
leader for Kool Smiles, and staff members, dress
up for Disney Day at one of the DSO’s South
Carolina-based offices

Building a strong dental team is not always easy, but it’s essential to the success of the group dental practice. Particularly as dental practices work to set themselves apart from their competition, a unified team has the ability to work efficiently and effectively, and instill a sense of confidence and trust in their patients.

Indeed, the way staff members interact with one another impacts their ability to communicate with their patients, according to Kimberly Kelly, area business leader for Kool Smiles. She maintains that when the dental staff communicates well with one another, they are more likely to reach out to patients in much the same way. Kool Smiles patients receive information “in a pleasant and informative way,” she says. “They can hear a smile over the phone; a smile in person is even more effective.

“At Kool Smiles, we focus on creating a memorable patient experience,” Kelly continues. “We try to understand what more we can do in our group setting to give our patients exceptional care in an inviting environment. The teamwork amongst our dental staff, and their ability to work cohesively and efficiently, has a tremendous impact on the patient’s overall experience. The way our team communicates, interacts and works together can be a major determining factor in whether or not we retain a patient and, in turn, whether that patient recommends us to others.”

The goal is to make patients want to come back, Kelly explains. “If they have a pleasant experience – from their first phone call to the last dental assistant that walks them out – they are more likely to return to us. It really is a group effort.”

The role of the DSO
Dental service organizations can help establish and implement programs that encourage a culture of teamwork, Kelly points out. For one, creating consistency and ensuring common practices throughout large group dental practices – whether across multiple cities or states – “ensures a seamless experience for both staff and patients,” she says. Whether patients walk into a Kool Smiles office in Texas or South Carolina, they’ll have the same experience, she points out.

It’s also important to incorporate fun at the workplace, she notes. “At Kool Smiles (and our support services organization, Benevis), teamwork and fun are two of our values, and we place a huge emphasis on both,” she says. And this is apparent to their patients, she adds. “They can tell when they come through our doors that teamwork [and fun are] part of who we are as an organization.

It’s in our DNA!

Looking ahead, Kelly anticipates that teamwork and cohesiveness among the dental staff will become increasingly important. “Healthcare and the dental industry are ever-changing, and we have to be willing to change with it,” she says. Advances in technology and tele-dentistry could present challenges, she notes, particularly as more work is accomplished remotely. “This [can be] a great time saver and it’s popular with team members, but it’s harder to create that team atmosphere when we’re not all in the same place.” Organizations such as Kool Smiles that have built their foundation on teamwork and communication will have an advantage, she adds.

Moods and Emotions

By Randy Chittum, Ph.D.

We have made much progress in understanding how emotions predispose us to behaviors, and even success. We have spent less time talking about moods, an important corollary. The best way I’ve heard the distinction expressed is that you can think of moods as the climate and emotions as the weather.

Climate (and moods) are reasonably prevalent and provide a long-term context for understanding, and even prediction. You generally know what to expect if you visit a tropical climate as opposed to a desert climate. Emotions, on the other hand, are less prevalent and more susceptible to change AND are heavily influenced by mood. This is also true in the weather analogy – the weather is influenced by the climate.

Language is important. In the same way that emotions do not equal “emotional,” mood is not the same as “moody.”

While emotions may be a response to a particular set of circumstances and may change rapidly from one circumstance to another – mood is much less likely to change over long periods of time. Some have argued that we have moods that stay with us a lifetime. My belief is that moods do change, though it may be years in the making, and may require significant desire and “internal” work.

Organization cultures (and sub-cultures) have moods. Julio Olalla is a significant figure in the world of linguistics, coaching, and organizations. He has proposed four primary moods.

  1. Resentment. A person or organization in this mood rejects or opposes facts, which are primarily based in the past (Resentment may show up as bitterness).
  2. Resignation. A person or organization living in resignation rejects possibilities, which are primarily based in the future (Resignation may show up as “giving up”).
  3. Peace/Acceptance. A person or organization living in peace accepts the past – not just acknowledges it, but truly embraces and accepts it in its entirety, including mistakes and regrets (Acceptance may show up as centered, comfortable in “one’s own skin”).
  4. Ambition. A person or organization living in ambition accepts and embraces possibilities (Ambition may show up as hopeful).

Can you imagine how someone living in a mood of ambition will approach life differently from someone living in resignation?

Can you assess your own dominant mood? If so, what strategies have you learned to help you stay effective? (Any mood in its extreme is likely to create barriers to effectiveness.)

How about others? Do you notice what others have as their dominant mood? How do you lead someone whose mood is resentful, or resigned?

Spend some time over the next few weeks noticing your prevalent moods. Do they change by circumstance, or as expected, are they somewhat more permanent? While we often wish to change what is around us, the big move may be changing that which is within us.

Sept/Oct 2016

egp-septoct16-cvrClick Here to Read the current issue
(w link to PDF download)

An Eye for Innovation
DSOs ensure their members are equipped with cutting edge technology

From The Publisher
Tackling Key DSO Trends

Mike Bileca looks to the future…

Balancing Act
Your hygiene schedules are your revenue solution

How to Improve Productivity While Reducing Stress

Taking Care of Business
Dental Care Alliance supports affiliated dentists’ focus on patient care

A Lifelong Learner
Dr. Katherine Schrubbe reflects on her 40-year career in dentistry, including her role in quality assurance

Diabetes and Oral Health
Working as a team, oral healthcare professionals, diabetes educators and primary care providers and endocrinologists can deliver services that result in better healthcare for diabetic patients

The ideal choice
When beautiful, long lasting restorations are at stake, Aquasil Ultra fits the bill.

The True Cost of Dental Equipment
To get your money’s worth, look beyond the price tag.

OSAP Safest Dental VisitTM
Boot Camp

Developing Others
What you should commit to while trying to bring out the best in your team members


The Upside of Rejection

Premier Dental introduces new products

Premier® Dental Products Company introduced the innovative Big Easy® Implant Inserts, designed to make power scaling work for you. The no-scratch tip will safely and quickly clean around implant surfaces and is also ideal for sensitive patients. The innovative design features a permanently attached tip made from PEEK. There is no need to keep track of disposable tips or a special attachment tool. PEEK is autoclavable and very tough for long lasting performance. Premier inserts are made in the U.S.A. with 100 years experience and are compatible with most magnetostrictive hand pieces.

Premier’s Spot-On™ Etch is a 37% high viscosity phosphoric etch gel for routine and selective-etch procedures. It’s designed with enhanced viscosity that will prevent it from dripping or slumping. Spot-On Etch easily flows through a small applicator tip, washes off readily and resists drying out. Key benefits include:

  • Ideal for routine etching and selective-etch procedures
  • Blue color provides a strong contrast to enamel and dentin
  • No-slump formula
  • Easy handling
  • Rinses clean without leaving residue

Premier® Dental also announced the addition of VACU BLAST™ a liquid evacuation system cleaner to our current line of successful cleaning products. VACU BLAST is a powerful enzymatic liquid evacuation system cleaner compatible with all amalgam separators. Its metered-dose bottle makes it easy and economical to use in each operatory to keep evacuation systems operating at peak performance. VACU BLAST’s features and benefits include:

  • Powerful enzymatic cleaner – removes blood, saliva, prophy paste and gel, debris that clog evacuation lines
  • Neutral pH – compatible with all amalgam separators
  • Non-corrosive – safe on all evacuation systems and plumbing
  • Non-foaming – protects pump parts
  • Versatile – can be used effectively with or without an atomizer
  • Metered-dose packaging – easy to use, economical
  • Eucalyptus – refreshingly pleasant clean scent
  • Environmentally friendly – promote ‘green’ products into the dental office

For more information, visit www.premusa.com.

How does your group practice measure up?

By Heidi Arndt

One of the biggest hygiene opportunities within the dental group practice is the opportunity to improve on the diagnosis and treatment of periodontal disease. Having a tangible way in which to measure a team’s effectiveness with treatment periodontal disease lies within one important indicator – the periodontal percentage.

The periodontal percentage is the best Key Performance Indicator to review how well a team is addressing periodontal disease. The periodontal percentage provides a look at how many of the patients are treated for periodontal disease vs. receiving a prophy.

In 2012, the CDC released a report stating that half of American Adults suffer from periodontal disease. (And remember, this number does not include “gingivitis”, as many earlier statistics did.) The rate of periodontal disease went up to 70 percent with patients over the age of 65.1

Clearly, periodontal disease is prevalent in adult patients. It does not matter where we live, how much money we have, how well educated we are … periodontal disease is affecting a large amount of the patients in every practice.
There are several ways to calculate the periodontal percentage, but here is the best calculation:

SRP Quadrant (D4341) + SRP Localized (D4342) + Periodontal Maintenance (D4910) + Prophy (1110) = A
SRP Quadrant (D4341) + SRP Localized (D4342) + Periodontal Maintenance (D4910) = B
Periodontal Percentage = B/A

The periodontal percentage looks at the definitive non-surgical periodontal therapy codes measured against the number of adult prophy’s performed in a practice.

There is one challenge with this calculation that should be addressed. While the adult prophy is a measure of 1 patient; the 4341 or 4342 code will calculate up to four times for 1 patient. Thus, the periodontal percentage is the calculation of procedures only, not of actual patients.

Making sense of the percentages
So, what does the periodontal percentage mean?

Is the team’s percentage above 60 percent?
If so, the team is delivering a very high level of non-surgical periodontal care to the patients. It is effective at assessing, educating and enrolling patients in necessary treatment.

Areas to focus on: Continue to focus on the periodontal therapy program and attend continuing education events to ensure the team is always providing the best of care.

Is the team’s percentage between 40 to 60 percent?
This is better than average. However, there are several opportunities that still exist.

Areas to focus on: Review the periodontal therapy program and focus on effective and consistent communication with the patients, and between all providers. Ensure everyone is speaking the same language to increase treatment acceptance.

Is the team’s periodontal percentage below 30 percent?
This periodontal program needs immediate attention. Most of the patients are receiving prophy’s and there is a good chance there is a high amount of untreated periodontal disease in the patient base. A low periodontal percentage is one indicator that it is time to evaluate the quality of the assessments and diagnostic care occurring in the hygiene chair. The first step to increase the periodontal program is assessing the patient and making a clear diagnosis. A strong and consistent assessment will guide you to a periodontal diagnosis for the patients.

No matter what your periodontal percentage lands, the first place to focus on is the Periodontal Assessment. The dental hygiene team must complete a comprehensive periodontal assessment on every adult patient, with a full documentation in the patient record once yearly.

According to the Academy of Periodontology, the comprehensive periodontal assessment should include: A review of the patient’s current healthy status, history of disease, and risk characteristics. The dental hygienists must then record the probing depths, recession, mobility, furcation, bleeding and exudate.2

Using the comprehensive periodontal assessment, the dental team can develop a logical plan of treatment to eliminate the signs and symptoms of periodontal disease. The Academy of Periodontology website www.perio.org, provides numerous resources to help support a strong periodontal therapy program.

In addition, the team should attend a continuing education course focused solely on the development and implementation of a non-surgical periodontal therapy program. Your periodontal therapy program does not need to be elaborate. In fact, the best and most effective plans are created for simplicity and easily implemented into any office. Enhanced Hygiene (www.enhancedhygiene.com) offers several courses throughout the year focused on periodontal therapy programs.

Placing a focus on your periodontal therapy program will improve the level of patient care and service you provide in your group practice; and, improve your hygiene revenue.

1. P.I. Eke, B.A. Dye, L. Wei, G.O. Thornton-Evans, and R.J. Genco. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. J Dent. Res. 2012.
2. Comprehensive Periodontal Therapy: A Statement by the Academy of Periodontology. J Periodontal, July 2011.

October 2013

Click Here to Read the October issue
(w link to PDF download)
From the Publisher
All Smiles
The Smile Source business model allows independents to thrive

A Clear Direction
The importance of hygiene leadership in the dental group setting

First Medicine, now dentistry
It’s time for a culture of patient safety in the dental setting

Leadership and Managment
Achieving Practice Efficiency with Multi-Disciplinary Care Teams

Here to Stay
How group practice can successfully operate in a managed care environment

Chairside Efficiency Begins with the Chair

Instrument Management: An Excellent Safety and Efficiency Strategy

The Lean Dentist
After seeing the results in his own practice, one dentist is translating a successful
management system made famous among manufacturers into dentistry best

Moving the Needle
Why small bits of progress matter more than you think

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