Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Dental Lab Products. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.

Making the Grade: Do Dental Practices Need Hospital-level Infection Control? Photo courtesy of DC Studio/stock.adobe.com. 


At first blush, one might assume that hospitals must adhere to higher infection control safety standards than dental practices. After all, hospitals handle complex medical cases such as surgeries, childbirth, and emergency care. Patients and clinicians at a hospital need protection from all sorts of risks.

But, thinking that dental practices don’t need to adhere to a similar level of infection prevention is simply not true. The reality is that both need to observe meticulous levels of care.

“Having been in dentistry for a long, long time, I understand some of the misconceptions or confusion – or perhaps old ideas that don’t go away in a lot of industries,” Peggy Spitzer, dental hygienist and clinical education manager for Certol International observes. “In dentistry, we’ve oftentimes felt, ‘Well, we can’t kill anybody and it’s just dentistry,’ ‘It’s non-invasive,’ ‘There’s a lower risk,’ I guess that’s probably what it comes down to – people feel like it’s a lower risk. They don’t understand that there are some significant changes, and no matter what, it’s patient care and it’s about the health and safety of the patient.”

Team members in both environments must observe much of the same standards of infection control.

“If we’re looking at environmental cleaning in the dental setting and the hospital setting, those should be very similar,” Joyce Moore, RDH, an infection control consultant and clinical instructor at Bristol Community College in Fall River, Massachusetts says. “The cleaning and disinfecting procedures and the chemicals that we’re using should very much align.

“There are some differences with hospitals,” she says. “Unlike dental, there is a higher focus on dust mitigation, and that’s not going to apply so much to the dental setting. Dust can contain a lot of contaminants. If you are in a surgical setting, you would not want dust getting into an open wound site.”

While hospitals see patients with varied medical needs, it’s important to remember that dental clinics serve patients with their own unique health concerns, underscoring just how important it is to maintain proper infection control.

“Dentistry is much more invasive than people may realize,” Spitzer observes. “And it’s getting more invasive. General dentists are doing more and more surgery. They’re placing implants. They’re doing some aggressive, very invasive procedures.

“And the other corollary to this is that people are coming into the dental office that never came in before,” she continues. “There are people in the middle of cancer treatment. There are people undergoing all sorts of extensive procedures or have a heavy-duty medical history. In the past, they simply were not healthy enough or didn’t survive long enough to have dental care. And now you have this combination of more invasive procedures on people who may be more at risk and they’re more immunocompromised. Those 2 factors alone would be a great concern, but the germs don’t care. The germs are out there and they’re opportunistic. They’ll take any advantage. And if we give them 1 small opening, they’ll go for it.”

Another difference is that hospitals have more equipment to sanitize – both medical and incidental.

“In dental, we are fortunate in that we simply don’t have as much equipment as they do in the other settings, because they’re looking at patient monitors and ultrasound equipment and infusion pumps, and they’re also looking at things like TV remote controls and call lights,” Moore says. “So, in the dental setting, yes, we are a medical profession, and we should have cleaning and disinfection and invite environmental cleaning standards that are very similar to the hospital. But there will be things that we don’t have to contend with, like those items.”

As with anything in the last couple of years, COVID-19 has demanded a new level of safety.

“Dental settings – and just everybody in medical, because of COVID – have had a spotlight shone on what we were doing,” Moore observes. “And it’s had people reassess their policies, their procedures, and the way they practice. In dental, where we get away from medical, is that we don’t have separate, dedicated staff to perform these tasks. So, when it comes to the dental hygienists, the dental assistants, the dental practitioners performing those environmental cleaning procedures, we are doing pretty well, but we really need to be looking at the chemicals that we’re using and how we use them. So, across the board, I think it’s important to have your dental staff looking at how to properly use these items, especially because with COVID, we weren’t always able to get our usual products.”

There is also the reality of dental practices’ sizes, when compared to hospitals, and practitioners’ attitudes that may affect the levels of environmental sanitation.

“There’s just a lot more out there circulating now,” Spitzer says. “I’m afraid that that’s been very pervasive and it’s changing, because, unfortunately, I think there’s still the financial pressure that weighs heavily in dental. In many instances, it’s a single-practitioner, cottage industry type of setting, where you’re not in a group setting. You’re responsible to yourself. You should be responsible to the patient, but there’s very little oversight on a day-to-day basis, even in group practices. The dentist is in the room with the patient, the dental assistants, and the instrument processing area by themselves.

“There’s just not much oversight or group attention, and there’s not a lot of regulatory oversight and there’s not a lot of inspections,” she continues. “All those factors are playing into this situation, so that people will say, ‘Well, we don’t have to do that,’ ‘We don’t have to do these extra steps or extra monitoring devices when we’re doing sterilization,’ ‘We don’t have to worry about doing all these steps of instrument cleaning,’ ‘If it’s excessive, it’s too much, we don’t have to package our handpieces. We can just sterilize them and throw them in the drawer,’ There’s a lot of these sorts of things that I think are alarmingly common. We’re way past that. Now we have plenty of research and plenty of resources that we can all be doing better.”

Maybe one of the biggest factors when comparing dental practice and hospital infection control measures is that dental practices simply have fewer resources.

“Larger facilities have a dedicated instrument reprocessing space, and they tend to have a dedicated person for that task,” Moore observes. “In dental, that instrument reprocessing is not given as high a level of focus as I’d like to see as it is in the hospital or ambulatory care setting. There are considerably more specific guidelines that are followed, even as far as instrument storage. In the dental setting, we say keep away from damp areas and under sinks and such, but within the hospital setting, there are more specifics. For instance, it has to be so many inches away from a wall; so many inches off the floor; et cetera. So, that’s getting really specific, but as far as instrument reprocessing and storage of instruments, I think medical has a higher level than we do.”

Even though dental practices have fewer resources to work with, they are still expected to maintain a similar level of protection.

“There’s no difference, just because you have a smaller setting, smaller equipment,” Spitzer says. “In hospitals, in the areas where they process instruments, the standard is that the dirty area should be physically separated by walls and doors from the clean areas. So, on the dirty side, they receive the dirty instruments, and there’s a lot of soil and germs and things flying through the air. And then on the clean side, they’re receiving clean instruments from the washers, and everybody’s hands are washed and they’re handling all these clean items. They’re not sterile, but they’re going to be putting them in the sterilizer. In dental office, you’ve got 1 tiny area, sometimes it’s just 10 feet of countertop, if you’re lucky, where you’re going from very dirty to very sterile.”

The best way for clinic staff to ensure a high level of safety is through education.

“People who know better are more likely to do better,” Spitzer says. “They need to look up the guidelines, get staff trained, and follow the guidelines. There are so many things that are simple, basic, and not expensive. This is not stuff that’s super expensive. It’s taking time to really clean the instruments properly and having a few simple things, like a drying drawer – a drawer that you can purchase and install that dries your instruments before they’re packaged and sterilized. This stuff is not billions of dollars. It’s a relatively modest cost. I think people overplay the cost of doing it the right way as an excuse for not doing it the right way.”

It may seem like hospitals demand a higher level of infection prevention than dental practices, but, for the most part, both environments need the same level of protection. And, while hospitals tend to have the resources to easily achieve that, dental practices must do at least as much with less.

Articles

While it may be difficult with less resources, it is just as important for dental practices to adhere to the same level of infection control as hospitals

Making the Grade: Do Dental Practices Need Hospital-level Infection Control?

Zest Dental Solutions has announced the release of ENCOMPASS™, an all-inclusive, digitally-powered overdenture treatment system through a partnership with Absolute Dental Services. ENCOMPASS can reduce patient visits by 50%, while providing them with customized, high-quality overdentures, according to a press release from the company.

Each ENCOMPASS bundle box includes an Absolute NavaGation™ Pilot Guide and treatment plan; 2, 4, or 6 all-in-one Zest LOCATOR Implants and Abutments with processing pack; a premium Absolute Forever Denture™; CHAIRSIDE Attachment processing Material; Denture Removal Tool; CHAIRSIDE Rubber Finishing and Tapered Carbide Burs; Fixation; and a Denture ID microchip. The end result is said to be a comprehensive solution focused on precision and efficiency.

This cloud-based, digital workflow is designed to deliver enhanced case planning and efficiency for the clinician, streamlining the entire process to help reduce patient visits by as much as 50%, the company states, freeing up valuable chairtime. The ENCOMPASS Pilot Surgical Guide further adds to this precision and consistency, allowing the clinician to maintain the correct depth and placement for optimum overdenture support and patient comfort.

The Lucitone 3D Carbon Printed, Absolute Forever Denture that is included in the bundle is a 3D, custom-printed overdenture that is reportedly 3-times stronger than the minimum ISO strength standard for a denture. Created on a Carbon® M2 printer, each overdenture is the perfect combination of precision, strength, and esthetics. It is designed to give clinicians the ability to customize the tissue portion with 5 different shades of pink, adding to a realistic outcome.

The precision overdentures are held in place with 2, 4, or 6 LOCATOR abutments and implants. The progressive diameter design, self-tapping tip, and RBM-treated surface allows clinicians to place Zest implants in both standard and narrow ridges.

This digitally powered overdenture treatment is designed to reduce patient visits by 50%.

Zest Dental Launches ENCOMPASS Overdenture Solution

Amann Girrbach has released an update to its Ceramill software. Ceramill 4.0 now integrates exocad Galway and numerous other functions. Users can now work with greater clarity and efficiency in a uniform workflow—from the Ceramill Scan software and the Ceramill Mind through to the Ceramill Match 2 and Ceramill Motion.

Its Auto-Antagonist function determines the exact alignment of the 2 jaws based on an algorithm. Then the software’s Auto-Morphing function automatically adapts the tooth anatomy to the antagonist and the surrounding area, as well as automatically changing the spacing and fissures. The result is harmonious integration into the patient's dentition.

Additionally, the update offers a number of other functions. The insertion direction can be adjusted intuitively and conveniently and an improved view on the indication provides the opportunity for an immediate assessment of the impact. Scaling, rotating, modifying, and copying the connectors is possible from 3 different perspectives due to the Multi-View feature, enabling adaption to the restoration with precision. The M-Smile feature will recognize the eyes and lip lines as well as allow for the fabrication of the matching mock-up for the patient with the aid of the 3D printer for a direct fitting—even before the final restoration.

Other new features include the option of saving full dentures as standard libraries, the time-saving Auto-Articulation, as well as a more efficient algorithm that can reduce matching time by 37 percent (when using the Ceramill Map 600+) or up to 65 percent (when using the Ceramill Map 200+).

Ceramill 4.0 now integrates exocad Galway and numerous other functions.

Amann Girrbach Updates Ceramill Software

Aspen Dental Management, Inc, has announced a partnership with digital dentistry company SprintRay. This partnership is a multi-year, strategic partnership that is said to equip Aspen Dental practices with SprintRay’s 3D printing technology across 45 states. SprintRay CEO and Co-founder Amir Mansouri said that it is of utmost importance that patients have access to new technologies for better outcomes.

“Innovation in dentistry is about leveraging technology, new biocompatible materials and big data to enhance the speed of high-quality treatment,” Mansouri said in a press release from the company. “By equipping every Aspen Dental practice with SprintRay’s industry-leading, frictionless 3D printing workflow, more patients will have access to transformative, high-quality dental care, delivered arm’s length from the patient and chairside in each Aspen dental practice.”

This partnership was said to be done as a part of Aspen Dental’s commitment to integrate modern technologies into its care processes. This means every practice having a SprintRay 3D printing system in its armamentarium. Aspen Dental Chief Clinical Officer Dr Awinder Judge said that delivering care was the most important factor in partnering up.

“As part of Aspen Dental’s ongoing effort to integrate technological innovations into our care delivery process, we are excited to partner with SprintRay to embed their end-to-end 3D printing ecosystem in every Aspen Dental practice nationwide,” Dr Judge said in the press release.

Aspen Dental practices will be supplied with SprintRay’s 3D printing technology to deliver better outcomes for patients. 

Aspen Dental Partners with SprintRay 

Ivoclar Vivadent Announces New IPS e.max Prime Esthetic


Ivoclar Vivadent has announced the release of its new IPS e.max Prime Esthetic zirconia ceramic. It is said to combine efficiency and esthetics through its layer-free progression of shade and translucency. It provides incisal areas with high levels of translucency and cervical areas with optimally coordinated levels of opacity and an 850 MPa strength.

The IPS e.max Prime Esthetics is a combination of 2 zirconium oxide materials, and is available in a range of 16 A-D, and 4 Bleach shades in 3 disc thicknesses (14 mm, 16 mm, 20 mm) with a Ø 98.5 mm diameter. It also utilizes a Gradient Technology (GT) to achieve the esthetics that are said to make this ceramic stand out. Two zirconium oxide raw materials are combined in the manufacturing process to produce the single material. This material combines 4Y-TZP zirconium oxide raw material and the 5Y-TZP zirconium oxide raw material.

IPS e.max Prime Esthetic utilizes a filling technology to provide the material with shade and optimized translucency, and visible layers are no longer visible with IPS e.max Prime Esthetic. It also utilizes advanced powder conditioning to adjust sintering kinetics and ensure a uniform shrinkage behaviour across both materials.

In these innovations, IPS e.max Prime Esthetic is designed to achieve both efficiency and esthetics, making it a potential go-to for future restorations.

This new zirconia ceramic promises efficiency, durability, and strong esthetics through its materials and innovations. 

Ivoclar Vivadent Announces New IPS e.max Prime Esthetic

Bruce Bryen is a certified public accountant with over 45 years of experience and is a part of Baratz & Associates CPAs. He specializes in deferred compensation, such as retirement planning design; income and estate tax planning; determination of the proper organizational business structure; asset protection and structuring loan packages for presentation to financial institutions. He is experienced in providing litigation support services to dentists with Valuation and Expert Witness testimony in matrimonial and partnership dispute cases. He is also a financial writer for several dental journals. You may contact him at 609-502-0691 or at 

When most dental practice owners and advisors think of a retirement plan, they are looking at the current and future year’s income tax and planning for the eventual transition of the dental practice once they retire. This is when the dentist’s expected annual income will decrease, and the deferred compensation accumulated without tax in the retirement fund will be used for the peaceful life the dentist and their partner expect to enjoy.

Of course, this is a wonderful plan for the current and future income tax and retirement plan savings and will put the tax bite on the lower level each year the dentist is working while building up an endowment for future economic benefits. When this time comes, the selling dentist and their advisor will almost always look for capital gains tax treatment to obtain the lowest current tax possible on the sale.

This always creates a problem for the buyer of the practice, as the capital gains tax to the seller almost creates an ordinary income tax for the buyer. This is because amortizing the allocation of the purchase price to a capital asset, such as goodwill, for the buyer is a 15-year write off term against their ordinary income, whereas the seller has a low tax rate via the capital gains tax treatment. If the buyer wants the practice badly enough, they pay the highest tax over a short term to obtain it.

These following paragraphs report a sophisticated approach to a transition that offer a unique way for the seller of the dental practice to defer taxes for a long time and enjoy more funds than the capital gains tax treatment affords. The tax comes from money that would not exist, except for this approach, and the tax after subtracting the money earned is less than the capital gains tax. It also assists with the allocation of the purchase price, so the buyer and the seller each gain substantial savings and an accumulation of funds.

How Can Taxes Be Lessened So the Buyer and Seller Each Benefit From the Transition?

The advisors and dentists have created ideas by using the retirement plan to create a current tax savings boon for the dental practitioner. The transition framework of the dental practice can be designed, so the seller receives a better than capital gains treatment upon the closing based on the funds accumulated, which would not have been available had the capital gains tax been paid. The buyer also receives a definite improvement to their tax treatment once the transition occurs since more ordinary income tax write offs occur for the buyer. The plan to do this for the buyer and the seller of the dental practice is to use a similar mechanism for the transition as during the operating years of the dental practice.

It may be that the seller had a 401k/profit sharing plan in place during the career as a practicing dentist. In a typical sale, assuming the selling dentist is older, a new type of retirement plan would probably be used to substantially reduce the current tax on the sale. The type of retirement plan would most likely be a defined benefit plan where the gist of the formula for write offs is one where age is an important ingredient as to the amount of money. Unlike the 401k/profit sharing plan or a Simple IRA where statutory amounts are predetermined, the defined benefit plan works on a formula based on age, compensation, years of service, and other important ingredients to allow for higher contributions to the seller, who is older and has earned more than the other employees.

 
An example of the mechanism of deferring and funding is as follows:

First, a defined benefit plan is adopted by the dental practice that is being transitioned. Based on the staff ages and compensation, it may be that an additional 401k/profit sharing plan is needed for the nonkey employees. Instead of paying the seller the sale price at closing, a contract is prepared along with the adoption of the defined benefit plan to pay the amount over a term but primarily into the defined benefit plan. As an example, if the sale price was $1,000,000 and the seller was in a high state income tax environment, the federal and state tax would be roughly 30%. That would create a tax of $300,000, leaving $700,000 upon the closing. Hypothetically, with the sophisticated adoption of the retirement plan and the contract for funding, approximately $200,000 plus interest would be paid into the defined benefit plan for 5 years and would escape any income tax until the funds were withdrawn. Effectively, the seller upon the transition with a capital gains treatment would have $700,000 to invest. With the sophisticated retirement plan sale adoption, there would be $200,000 per year plus earnings to invest for 5 years, then the balance of the remainder for however long the seller wished. Approximately $1,000,000 would be in the account after 5 years for investing compared with the $700,000 after the capital gains tax.

Additional Information Should Be Obtained to Insure Proper Reporting and Contract Format


This plan is very complex, but if it’s done right, it will save and earn the selling dentist thousands of dollars more than an outright sale using capital gains treatment for taxes. A sophisticated dental certified public accountant with experience in implementing this type of plan should be retained for this purpose. Not only does this benefit the seller but the buying dentist will also save even more than the seller based on the ability to write off large amounts of the purchase price quickly. Instead of the goodwill amortization of 15 years that would have occurred and cost the buyer substantial amounts, a hypothetical 5-year term, as described in the seller’s section, will allow the buyer the same 5-year term of write offs as the payments are being made.

If the advisor retained by the dental practice is in a fog about how this works, someone should be retained who understands how this occurs and should be able to explain it with a common sense approach, so the buyer and the seller have no doubts of its ability to save.

Dental advisors and dentists have some ideas on using retirement plans to create a current tax savings boon for the dental practitioner.

Tips to Reduce the Tax Upon Transitioning the Dental Practice

ADA SmileCon - Interview with Whip Mix DTS Sales Manager Chris Frye


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In this video, Whip Mix DTS Sales Manager Chris Frye displays the innovative VeriONE Digital Workflow from Whip Mix at ADA SmileCon 2021. 

ADA SmileCon 2021 - Interview with Whip Mix DTS Sales Manager Chris Frye

ADA SmileCon 2021 - Interview with DocSites Co-Founder Parham Nabatian


In this video, DocSites Co-Founder Parham Nabatian discusses the platform's unique offerings to practices and dental professionals at ADA SmileCon 2021. 

ADA SmileCon 2021 - Interview with DocSites Co-Founder Parham Nabatian

ADA SmileCon 2021 - Interview with Aurident Sales & Product Manager Jimmy Ruiz


In this video, Aurident Sales & Product Manager Jimmy Ruiz discusses Aurident's new innovations and offerings at ADA SmileCon 2021. 

ADA SmileCon 2021 - Interview with Aurident Sales & Product Manager Jimmy Ruiz

3Shape has launched a new open platform to manage and expand digital dentistry called 3Shape Unite. 3Shape Unite is included with every TRIOS intraoral scanner and is said to have an intuitive user interface that allows for a smoother workflow. The built-in lab order form and chat functionalities can make digital dentistry easier and more accessible, according to 3Shape CEO Jakob Just-Bomholt.

“3Shape Unite is a tremendous launch for 3Shape! It brings to life our historic vision of giving dentists freedom and open options. It is digital dentistry united under one platform. From labs and treatment solution partners to managing patient care, 3Shape Unite creates workflows that just flow,” Just-Bomholt said in a press release. “For dentists, 3Shape Unite simply and openly connects them to the right dental partners and makes digital dentistry easy, end-to-end.”

This platform can connect practices to labs, making digital integration more straightforward. Henry Schein, Ivoclar Vivadent, and the Straumann Group have all teamed up with 3Shape to launch the Unite platform, meaning greater access to practice management systems, clear aligners, implants, restorative solutions, and more benefits from this partnership.

Laboratories and practices can both utilize this platform with their TRIOS scanner. The 3Shape Unite platform will be available online and TRIOS MOVE via software updates in December, 2021.

The 3Shape Unite Platform will integrate digital workflows with TRIOS intraoral scanners to make digital dentistry more accessible to practices and labs. 

Tips to Reduce the Tax Upon Transitioning the Dental Practice

ADA SmileCon 2021 - Interview with Whip Mix DTS Sales Manager Chris Frye

ADA SmileCon 2021 - Interview with DocSites Co-Founder Parham Nabatian

ADA SmileCon 2021 - Interview with Aurident Sales & Product Manager Jimmy Ruiz

3Shape Launches 3Shape Unite Platform