Composite restorations require a detailed eye for technique. However, it would help if you also kept an eye out for these common technique mistakes: Failing to isolate, having poor layering technique, and allowing for insufficient curing. Each of these common mistakes can lead to problems with your restorations, up to and including restorative failure. We will look at each and how you can avoid them.  

Mistake #1: Failing to achieve field control.

 For the best possible outcome for the restoration, it is essential to have a preparation that sets you up for success. For bonding, it is crucial to have as pristine an environment as possible for the bonding agent. When you fail to isolate the preparation and control the fluid, you invite post-operative sensitivity, contamination, and microleakage to destroy your restoration. Moreover, it is not OK to have it "mostly" isolated. The field needs to be 100% clean and dry.

Which type of isolation you choose depends on several variables. The College of Dentistry and Dental Clinics for the University of Iowa lists them as:

The Rubber Dam is the "gold standard," per the university because it can effectively achieve the field control necessary to achieve a quality restoration. But supposing a rubber dam is not possible, they recommend alternative methods of isolation, including lip and cheek retractors, cotton, and cotton roll holders, Isolite, Hygroformic Saliva evacuation, and retraction cord, and hemostatic agents. However, they do caution clinicians that hemostatic agents can interfere with the bonding agent.

Whether they are the gold standard or not, many dentists do not like rubber dams and do not use them once they leave dental school. An excellent option is to train your dental assistant to place them for you. However, it is a good idea to check with your state board to ensure that your dental assistant can set up rubber dams there. 

Mistake #2: Not moving the curing light around during curing.

Polymerization of composite resin is crucial to the success of your restorations. Without proper curing technique, your restoration could have excessive polymerization shrinkage, reduce mechanical properties of the material, increase the residual monomers that can damage the tooth restoration, increase the occurrence of surface staining, and the chances of marginal leakage.

The dental light itself and light-curing technique can cause insufficient polymerization. For the dental curing light, the beam profile, tip size, and guide angle of your light affect the size of the light-curing area:

 Beam profile: Every curing light has a beam profile, which describes how the light distributes from the tip. Most curing light manufacturers want a uniform beam profile, but sometimes the curing light has more intense areas for irradiance than others. When the beam profile is not consistent, it can affect the microhardness of resin-based composites that could lead to premature failure of your dental restoration.v Suppose you move the light around the material during curing. In that case, you also move those more intense areas across the curing surface, ensuring that the entire area has its time to activate the photoinitiator.

Tip size: The tip size dictates where the active curing area is when using the light. In other words, the smaller the tip, the smaller the curing area. If you have a larger curing area, you need to use a light with a larger tip or overlap the active curing area to ensure that all the surfaces get the light. 

Guide Angle: The guide angle affects where the curing light tip can fit in the mouth and, subsequently, where the active curing area lands. So, if the guide angle does not fit, it can obstruct the lights' ability to reach the curing area. To get there, you might have to approach the restorative material's surface area from the opposite direction to light cure all the material. 

If you use a technique that does not account for these influences from your curing light, then you could end up with under-cured material and all the problems that go with it. By moving the curing light around the uncured restorative material in the oral cavity, you could help reduce the chances of insufficient polymerization.

Polishing is the last step of the restoration, but that does not decrease its importance in the composite resin restorative process. The polishing step not only makes the tooth feel smooth but also sets up the longevity of your restoration. Polishing the surface creates a more resistant plane to bacteria, staining, plaque buildup, and wear kinetics. Also, studies show if you do not reduce surface roughness enough, patients present with secondary decay, gum irritation, and inflammation. In addition, the friction and occlusal and opposing dentition wear can introduce microfractures into the surface.

However, polishing is another critical area that could be prone to errors. Unlike the curing mistake where you do not get enough, polishing too much can cause many problems with the material. Per the IJRD, polishing too much can build up heat, which changes the resin matrix, disrupts the post-irradiation phase of polymerization, and takes off the layer that likely has the best conversion. You also increase the risk of pulp injury by excessive heat.

The IJRD suggests ensuring that you plan for the restoration before you begin to optimize your polishing time. If you pack in too much material and then use the polish step to remove the excess, you could create an unfavorable condition for your composite's restorative success. The IJRD also suggests exercising caution with your burs to avoid damage to the margins and surrounding dentition. Preserving these crucial areas of your dental restoration helps deter the failure of the tooth/restoration interface.

In addition, you should leave enough time to polish. You have probably heard the saying, "haste makes waste," which holds if you rush the polishing step to make room for the next patient on the schedule. If you often feel squeezed for time at this point in the restorative process, try extending the amount of time you schedule for composite restorations by 10-15 minutes and see if that fixes the problem. While production rate is an essential metric to optimize for profitability in many dental practices, the extra time you add into the schedule for composite resin restorative treatments could make the difference between a restoration that lasts for several years and a restoration that you must fix in a few months for free

Dentistry.uiowa.edu. n.d. operative-field-control | College of Dentistry and Dental Clinics. [online] Available at: <https://www.dentistry.uiowa.edu/operative-field-control> [Accessed 18 June 2021].

de Camargo EJ, Moreschi E, Baseggio W, Cury JA, Pascotto RC. Composite depth of cure using four polymerization techniques. J Appl Oral Sci. 2009;17(5):446-450. doi:10.1590/s1678-77572009000500018

"9 Ways Your Dental Curing Light Could Be Putting Composite Restorations at Risk." bluelightanalytics.com. 8 June 2021. Web 18 June 2021. < 

https://www.bluelightanalytics.com/resources/blog/9-risks-dental-curing-lights-composite-restorations

LeSage, DDS, FAGD, FAACD, Brian. "Finishing and polishing criteria for minimally invasive composite restorations." General Dentistry. 2011 Nov-Dec; 422-428; Accessed via web. 21 July 2019. <

https://pdfs.semanticscholar.org/01f9/329480a6b9e8ac481dd57210c56b508d7542

Porto, Ph.D. I. (PDF) Post-operative sensitivity on direct resin composite restorations: clinical practice guidelines. ResearchGate. https://www.researchgate.net/publication/235977564_Post-operative_sensitivity_on_direct_resin_composite_restorations_clinical_practice_guidelines. Published 2012. Accessed June 19, 2021.

Articles

Composite restorations require a detailed eye for technique. However, you also need to keep an eye out for these common technique mistakes. 

3 Common Technique Mistakes That You Should Avoid When Placing Composite Restorations  

8 Dental CAD/CAM Technology Milestones

Dental CAD/CAM technology is no longer new, and throughout its more than 30 year history, these digital dental systems and accompanying materials have greatly expanded what can be done chairside.

Designed to enhance digital CAD/CAM possibilities for exocad users and dental technicians by providing simpler design solutions for complex cases, exocad GmbH (exocad), an Align Technology, Inc. company, has released PartialCAD 3.0 Galway, its module for removable partial denture frameworks, with new and advanced features for the design of high-quality partial dentures.

PartialCAD 3.0 Galway provides both experts and new users with smooth, improved integration with DentalCAD, exocad's leading software for dental laboratories. PartialCAD 3.0 Galway with new and advanced features to design high-quality removable partial dentures is now available. This new release offers a smooth integration with exocad’s DentalCAD.

Accurate fits from attachment-based partial framework designs without needing to scan the attachment itself or the accessory parts

Smooth interaction of the crown-and-bridge workflow and partial-framework workflow allows comfortable reverse planning of the whole restoration

Integration of partial framework design with DentalCAD enables the design of multiple separate elements like framework, teeth and gingiva

Reverse planning with exportable teeth and gingiva and the possibility to seamlessly combine secondary telescopic crowns with partial frameworks

"With PartialCAD 3.0 Galway, we give dental experts more flexibility in their design workflow," said Tillmann Steinbrecher, CEO and cofounder of exocad. "Custom partial dentures can be created and used quickly, helping those who require or request partials to smile brighter and improve their quality of life."

The PartialCAD 3.0 Galway release includes a range of new tools and benefits that empower dental professionals through more design freedom.

PartialCAD 3.0 Galway is available immediately worldwide as an add-on module or standalone module and can be accessed by all users with a valid upgrade contract. exocad names its releases after current "European Capitals of Culture" and selected the Irish city of Galway for this release.

Release provides new design possibilities for high-quality removable partial denture frameworks.

exocad’s New Module PartialCAD 3.0 Galway Includes Advanced Design Features

SmileFy Inc. has released the latest update of its smile design software, which features 3D Smile Design as a chairside solution for dentists to create facially guided mock-ups in-office within minutes. SmileFy’s 3D Smile Design is said to make the digital workflow simpler and reliable.

The software will allow dentists and dental labs to collaborate on patient cases directly from the software, improving communication and turnaround times. Treatment can be initiated with more accuracy by incorporating intraoral scans, 3D facial scans, and CBCT scans to predict and visualize the end result before starting treatment. Unlimited 3D Smile Designs can be exported as open projects for 3D printing and manufacturing with any CAD/CAM software.

Other SmileFy features include an intuitive user interface for dentists to access from any iPhone, iPad, or Mac; facially driven, natural-looking Smile Simulations generated by SmileFy’s artificial intelligence; Digital Patient module for a 3D view of the patient’s head using all your digital files; and an extensive library of natural tooth shapes.

The software allows dentists to create mock-ups in-office in just 1 appointment.

SmileFy's 3D Smile Design Software Enables In-Office Digital Treatment Planning

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 

For general dentists with some specialty skills and orthodontists who own their own dental practice, these hot issues are probably causing second thoughts about remaining with their individually owned practices. They are probably consulting with their dental CPAs and other financial advisors and getting information about what the DSOs and OSOs have to offer that they are not receiving on their own. It is important for them to first understand what they are receiving from their own practices so they can make a good comparison. 

One of the safest methods of determining what they are obtaining from their individual ownership is to have a valuation of their dental practice prepared using specific standards and to have it done by an independently certified valuation analyst. Many dentists feel that they know what the value of their practices are without the necessity of having the independently prepared valuation. They may want to save the money that it would cost to consult with the evaluator. This is a big mistake that can cost hundreds of thousands of dollars. A good analogy is the homeowner who thinks his or her house has a certain value which is usually higher than the buyer’s appraiser will provide. This means the loan won’t be granted for the purchase. With an in-house valuation that is not independent, the dentist is getting what he or she paid for it, which is probably nothing but what the dentist feels is correct as opposed to what is appropriate. 

The add backs for normalizing the profit are critical items when determining value. The comparison to national or at least local geographic averages are important for determining the normalization of certain costs so that the valuation appears as if a potential buyer and their lender would want it to appear. The independent valuation is the starting point. It tells the owner what the value of their dental practice is. Within the valuation is a calculation of earnings for the past few years.

Individual earnings and what the DSO or OSO offers compared to it

The general dentist who offers some specialties within the practice will earn a substantial amount of money each year. With tax planning, retirement planning, and overall good financial planning, the general dentist will be in a very good financial position when debating the issue of joining or not to a DSO. 

The orthodontist will most likely be in an even stronger position than the general dentist. So each of these practitioners will be comparing what they are currently earning to what they may be experiencing by joining either of these organizations. 

A dentist with a gross revenue of $1,000,000 will have a net income between $350,000 and $400,000 or more. An orthodontist will probably be even higher. If that is the case, it means that in 5 years the general dentist will have earned close to $2,000,000 while the orthodontist will most likely have earned close to $3,000,000 in that same time frame. The reason for using a 5-year term is that the service organization buy out with cash, stock and notes may approach close to 100% of gross revenue with some reservations but not all of the funds will be paid at the closing. 

The practitioner will earn money from the work they are doing for the service organization, but not anywhere near the amount compensated to the owner. The key, as with most of these service organizations, is what happens later when additional practices are acquired and more and more gross revenue is attained. The initial public offering or the acquisition by a larger DSO or OSO is certainly the key. Does the owner feel as if their own practice can duplicate or even exceed the service organization over a longer term than 5 years?

Specific positives and negatives of joining

Some of the specifics that the owner of the individual practice will consider include:

The ability to buy supplies cheaply within the organization.

Cheaper marketing costs because they will be shared among several practices rather than singularly.

A large reduction in administrative charges as they are spread among several offices.

No accounting, legal, or other financial considerations regarding hiring, firing, expansion, or lines of credit, and equipment financing. These areas will be controlled by the financial and personnel staff within the service group.

The above allows the dentist more time for espousing the attributes of the organization to their colleagues so more practices hear about the positives.

Perhaps most importantly, the ability to have an exit strategy in place as more and more practices are added to the number within the service organization. This is especially true for an older owner.

These are but a few of the many advantages of joining the individually owned practice into the service organization.

There are negatives to joining of course. One of the main problems is the lack of control in any of the areas mentioned in the positive points of the DSO or the OSO. For those who have started or acquired a practice and worked many years to attain the position they now find themselves, turning over their future to someone may be a hard pill to swallow. The bigger the group becomes, the less the prior individual owner’s voice will count as a vote since it will be 1 of many. The monied partner will probably be a venture capitalist, investment banker, or hedge fund, interested in a return and a big payday at the end of their investment. The concern for the patient may be lost.

A quick contrast for the owner who is thinking of joining is as follows:

We look at a hypothetical profit of $400,000 for 5 years and that comes to $2,000,000 for the individual owner. The DSO or OSO pays 100% of the gross revenue but not all in cash. Most likely it is 50% cash on which there is a tax of 50% federal and state. Hypothetically if the sale is $1,000,000 the owner will get $500,000 in cash on which a tax will be due of $250,000 approximately, so the owner gets about $250,000 up front with the balance of $500,000 over about 5 years. They also receive compensation based on production at up to about 35%-40% of the collections. This is not even half of what one would normally earn in an individual practice.

So, what is the real attraction to joining a DSO or an OSO? It is the pot of gold at the end of the rainbow. When an initial public offering occurs or when a larger more profitable DSO or OSO acquires the 1 just joined, the money involved will probably be more than the individual owner can earn on their own. This is years away. 

In 5 years, the owner has given up about $2,000,000 for what they are getting from the service organization. It is probably equal or even a little less than what the owner would have earned individually. However, if the service organization is well run, the individual owner will have lessened the aggravation faced every day in an individual practice. Will the pot of gold at the end be enough to sway the individual owner? That is the question.

Taking a look at some of the pros and cons of potentially joining a dental or orthodontic service organization. 

Should I Join a DSO? Should I Join an OSO? 

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.

By Alessandro Biascioli / stock.adobe.com

National Institute for Occupational Safety and Health’s (NIOSH) Hierarchy of Controls demonstrates a roadmap by which healthcare workers are protected from workplace hazards. What may surprise those unfamiliar with the Hierarchy, is that personal protective equipment (PPE) is the last line of defense. As such, it is particularly important that PPE does its job effectively, and the key to that is a proper fit.

Team members come in all different sizes, and PPE needs to fit each person appropriately, and that means having the right equipment for each person.

Given all the different sorts of PPE, can 1 size fit all?

“Certainly not gloves,” Dr Shannon Mills, DDS, observes. Dr Mills is a private healthcare consultant and Chair of the American Dental Association Standards Committee For Dental Products (SCDP) Subcommittee on Dental Infection Control Products. “Not really with masks, especially respirators. Surgical masks, yes. It’s pretty much one-size. There may be some variation, but as long as the medical masks fit snugly enough, what matters is there an adequate coverage of the surface you’re trying to protect? You want to keep contaminated spatter and and droplets off of your skin and your personal garments.”

Because everyone on the team is a unique size, achieving that coverage necessitates having appropriately sized PPE available.

“There’s a huge range,” Dr Mills observes. “You probably have dental assistants who might be might be 5’1”, and you have dentists who might be 6’4”, and obviously, the same size isn’t going to work for everybody. An apron or a gown that would work for your 6’4” dentist, that 5’1” dental assistant is going to be tripping over. You have to think about the areas that need to be covered if you’re wearing a gown. And, by the way, aprons are fine. Your back doesn’t get contaminated during these procedures. A lot of people open the back of the apron to be cooler, too. The main thing is you’ve got to cover your lap.”

Team members must have the right tools for the job.

“Something that I’ve noticed for years is that people would just put on a clinic jacket, or they put on a scrub top and say, ‘This is my PPE,’” Dr Mills adds. “Well, the thing is, if it’s not covering your knees and your waist, you’ve got this area that’s getting contaminated. Now, unless you have open sores on your thighs or something, and you’re wearing shorts, you’re not going to get a bloodborne pathogen, but you could still get potentially infectious agents on your clothes. You don’t take home COVID-19, you don’t take home HIV, but you could take home a cold that nobody needed to get.”

It is not as simple as just buying a few different sizes of gloves or gowns and then opening the door to patients. It is necessary to know what protection the practice needs.

“Before we even talk about the right size of PPE to get, we need to look at what PPE is necessary, and the office must conduct what’s known as a hazard assessment,” Karen Daw, “The OSHA Lady”, speaker and consultant, says. “The hazard assessment, in a nutshell, basically says, ‘OK, we’ve identified, in writing for OSHA, what hazards exist within our workplace, and then here are some engineering and work practice controls that we’re going to implement to protect against our employees against those hazards.’ And then, finally, here’s what PPE is going to be required. The employer is dictating, this is the PPE required when you’re engaged in this particular procedure. And then once you’ve decided, ‘OK, here’s the list of all the PPE we need,’ then you have to conduct what’s known as a PPE certification, and part of that PPE certification is asking questions of the team members: 

Do they understand the limitations of their personal protective equipment? Do they know the correct way to don and doff their PPE? 

Do they know the correct order to don and doff PPE the proper way? 

Do they know how to store it the proper way, to reprocess it the proper way, to maintain it? And part of it should be, does it fit correctly as well? 

Is it designed to protect the employee who’s required to wear it? Is it going to protect them to the best of its ability, and part of that consideration has to be size.

So, if I am an extra-large and you’re giving me a small or a medium, well, there are parts of me that are, potentially, going to be exposed to whatever that hazard is, whether it be spatter or spray or aerosols. And then, conversely, if I’m a petite person and I’m used to a size small, and you give me an XXL, this thing’s going to drape all over me. Not only is it not fitting me properly, but now it can also potentially get in the way of me being able to perform my job safely.”

Like street clothing, same sizes will vary from manufacturer to manufacturer. It’s a good idea to try out sizes from different manufacturers to get what fits best.

“As far as buying the PPE, sometimes it is a matter of trial and error,” Daw says. “One manufacturer’s size small might not be the same size small as another manufacturer. It’s the same with gloves or gowns. There’s no universal consensus amongst manufacturers of what those different sizes are going to be. So, for an office, it might be a matter of just of buying it and then seeing, ‘Hey, is the team happy with it?’ ‘Have they voiced concern about the ability of this personal protective equipment to protect them?’ ‘Are they not happy with the fit or the size of this PPE?’ And, if not, then maybe we need to consider another brand. It’s mostly going to be about trial and error, as far as getting the right fit.”

That doesn’t mean that the practice must be out of pocket during their quest.

“Get samples, have people try them on, make sure they tell you what size fits, and you make sure it covers them properly,” Dr Mills adds. “And then you just make sure you have enough for everybody in the practice. And you set your ordering and your reordering based on anticipated utilization.

“Now, if you don’t have anybody in your office that wears a small glove, then you don’t need to order small gloves,” he continues. “And if you don’t have anybody in your office that wears an extra-large glove or an extra-large gown, you don’t need them. You just have to find out what people need and then make your ordering match that requirement, based on anticipated use how many of these do you need a month. A lot of folks have their reorder set up with the vendors in some kind of an automated way.”

Throughout the SARS-CoV-2 pandemic, healthcare dealt with a shortage of various PPE, from masks to gloves. Those shortages added more complications to practices’ need for various-sized PPE. Happily, we seem to be out of the woods.

“Officially, there’s no longer any shortage,” Dr Mills says. “So, you can no longer use a shortage of PPE as an excuse for not following occupational safety rules. If your employee says, ‘My doctor won’t provide me the size that I need,’ and they complained to OSHA, OSHA will not accept shortages as an answer.

“You may have to look a little bit harder, but you can usually find it,” he continues. “If one vendor does not have what you need, then check different vendors until you find it. OSHA is no longer likely to accept that as an excuse.”

“For a little while, it was kind of touch-and-go with gloves,” Daw adds. “Not necessarily as far as sizing, but just the offices getting their preferred brand of gloves. We saw offices switching to another brand. And then again, that kind of poses some challenges as far as fit goes. But I think fortunately we didn’t see the case where we ran out of gloves, because if we ever ran out of gloves, we were, technically, supposed to limit or stop seeing patients at that point. If we don’t have the PPE to do our jobs safely and it’s required, then we technically need to scale back on the number of patients that are being seen. But we kept an eye on it and it looked like we didn’t experience that shortage.”

Ultimately, the point of PPE is workplace safety and, as with so many other things, most problems can be ameliorated through proper communication.

“I implore employers to communicate with their team,” Daw says. “Employers should have an open-door policy, and continually reassure the team that they have an open-door policy around communication. And what I mean by that is if the employee has a suggestion for PPE, or any other safety matter, that the employer communicates that, ‘Hey, anytime you have that kind of suggestion, I want to hear about it.’ Because, if the employee has been saying for a while now, ‘Hey, I’ve got utility gloves, but they’re too bulky. I need a smaller size than this,’ and the employer’s not listening well, then you’re potentially opening up your practice to liability as in a complaint to and possible inspection from OSHA.”

Maintaining an open line of communication with employees, especially as PPE is concerned, is critical not only to resolve shortages and poor fits, but also to ensure that employees feel respected.

“There’s a concern regarding employee safety here,” Daw says. “And many of the employees and former employees of practices that I’ve heard contact OSHA did so because they felt like they weren’t being heard. This is a great opportunity for us to remind employers that if an employee has a concern about PPE, whether it’s size or fit, it needs to be addressed. It doesn’t be about personal preference. ‘I liked this brand of gloves because they’re blue and you’re giving me purple gloves.’ No, we’re not talking about that. But if it affects performance, if it impacts safety, then employers better listen and make sure that they remind their team members that, ‘Yes, if there’s a better, safer way of doing something, I want to hear about it.’ And not only just to protect the employee, but also to protect the practice.”

Ensuring that each individual is correctly fitted in their personal protective equipment will ensure a cleaner, more protected practice. 

One Size Doesn’t Fit All: Ensure Everyone at the Practice has the Right-Sized Protective Equipment 

There is a lot to love about the summer months: The Fourth of July, barbecues, and for those who live in the northern part of the country, a welcome break from the snow and cold. However, that break can be fleeting. No matter where one lives, the temperature can go from warm and pleasant to hot and stifling in no time, and, for those wearing personal protective equipment (PPE), that warm temperature quickly becomes unpleasant. This may lead to some team members becoming lax with their PPE adherence. Obviously, this poses several safety problems. There are ways, however, to beat the heat and still maintain adequate level of safety.

PPE serves to protect dental health care providers and patients from potentially hazardous material. However, for some, that protective gear can become unpleasant.

“You’re going to have team members that are either always hot or always cold with PPE,” infection prevention consultant Dr Katherine Schrubbe, RDH, BS, MEd, PhD., says. “Maybe, if you’re too warm with your scrubs and your heavy clinic gown in the summer, you could go to a disposable gown which meets OSHA criteria, is much lighter, and will serve the same purpose.”

PPE comes in different styles, so it is important to ensure that whatever PPE variation that the practice gets suits its needs and any regulatory requirements. That selection can also include the distinctions necessary for comfort.

“There’s a big difference in different types of PPE,” Dorst says. “Say, for instance, the gown that we wear. OSHA states that the gown should provide protection from the splatters and splashes that we are exposed to and that fluid does not soak through to our clothing underneath. Fortunately, in dentistry, we’re not exposed to the large volume of fluids that we would need a fluid-impervious lining. So, if the office is buying those fluid-impervious gowns, look to the ones that don’t have that plastic backing, so to speak, on them. That will make them much more lightweight and breathable.”

Dorst says that team members who put in the effort may even be able to find equipment that is comfortable, aesthetically pleasing, and long-lasting.

“Over the years, as I’ve purchased different clinic jackets, and I’ve always worn what looks like a surgical gown.” she says. “I have a couple that I purchased almost 20 years ago that are made of a very breathable fabric. The gown is attractive with colorful floss and toothbrushes all over it. Even on the hottest of days, and working in the sterilization room where we’ve got all of those hot autoclaves constantly releasing steam and the warm ultrasonic solution, that type of fabric is much cooler for me.”

Researching different types of PPE is not just helpful for scrubs or gowns. The same is true of masks.

“Looking at different masks, when we go to the higher-level filtration mask, such as the Level Two or Level Three that we’ve been using during the airborne disease pandemic, it’s more difficult to breathe through those,” Dorst says. “If you have the mask securely fitted around your face for maximum protection, then it’s going to get hotter, but there are different mask brands that are more breathable. So, you just have to try several type masks. Get samples, if possible, from your dental distributor, from a sales rep, and find out which ones fit the best and provide you the greatest comfort.”

Team members can supplement their PPE with accessories designed for cooling.

“There are some very interesting, reusable cooling bead necklaces,” Dr Schrubbe observes. “You freeze the beads and they will stay cool for a period of time, and then you can wear them around your neck where they would not be seen through a clinic gown. Interestingly enough, if you’re going the more natural route, peppermint oil can trigger the temperature receptors on your skin. If you place a small amount of peppermint oil on the back of your neck it will trigger a reaction on your skin to provide a cooling sensation. There are also powders that you could use that are wicking and are specifically made to absorb moisture, et cetera. Their primary ingredient is traditionally cornstarch, but they do work quite well.”

“There are even available some vests and scarves that are cooling mechanisms, like you see with athletic equipment,” Dorst adds. “They have fabrics that wick away the moisture from the skin. Well, I’ve even seen these cooling vest that have chill packs that you insert in them if you are working in a really hot environment. I think we’re going to see a lot more innovative adaptations for PPE to give us that comfort zone. We need to be comfortable enough that we can focus on patients’ care and not be so hot that it compromises both our focus and our physical wellbeing as we care for patients.”

 brand of uniforms that are manufactured with temperature regulating fabric properties.

“They can keep you cool,” she says. “The fabric has a wicking material built right in it. The scrubs are a good quality and keep their shape. They also manufacture PPE clinic gowns and jackets which meet the criteria for what we need, and utilize a patented fabric that’s very temperature sensitive.”

It sounds like advice that anyone’s mother would give, and mothers tend to be right: Stay hydrated.

“One of the things that I’ve recommended to my clients is that they try to set up a hydration station that is close to the clinical area. The staff lounge may be upstairs or downstairs, or quite a long distance away from where the operatories are,” Dorst observes. “CDC and OSHA tell us, for basic infection control and safety, that we should not have any food or drink in the clinical area or in the laboratory. However, what we can do is find somewhere, a distance away from the operatory, or maybe in a side hallway, or maybe even in the supply room, that we can just have a countertop where we can keep closed containers, such as one of the sport water bottles or insulated beverage container. In between patients, a team member could step in there and safely remove their mask and take a drink of water and take a couple of deep breaths of air before they re-mask and see the next patient.”

“We don’t want to have a food or drink in the clinical areas, in the operatories at all,” Dr Schrubbe adds, “but if there’s a staff room or a lunchroom that you can take a little break, every so often, have really cool water ready to go so to stay hydrated and cool at the same time.”

Good hydration not only helps cool the team member, but helps with other physical needs.

“It’s for their wellbeing to stay hydrated, because I’m wearing the N95 respirators,” Dorst says. “Not only do you build up more heat, but it can actually increase the wearer’s blood pressure, and you’re rebreathing more carbon dioxide. So, they do need those breaks for the respiratory system as well as a hydration. Being able to schedule that hydration break and have it in a convenient area that they can quickly get to where they don’t have time, maybe, to go the further distance to the staff lounge is a big help for the clinical team.”

To keep the clinical team cool, it may result in the air-conditioning system being turned up to the point where front office staff, as well as patients, are freezing, even on the hottest summer days.

“We’ve always had the war-of-the-thermostat in the dental office,” Dorst observes. “The front office team wants it warm and comfortable, and then the clinical team, because of all that PPE and the equipment that they’re running, they want it at least 10 degrees cooler, if not more. I’ve always said that every office designer should design a dental building with two thermostats – one for the clinical team and one for the front office team. I know, as a dental hygienist, that during summer patients arrive for their dental appointment, dressed in lightweight clothing, maybe even kids coming in and shorts and t-shirts. We have the temperature so cold they’re shivering after they sit in the chair for 10 to 15 minutes. We even keep blankets available for the cold patients, but that adds another infection control challenge – laundering the blankets. There are some dental offices that when reminding patients of their appointment, the office includes, ‘Please come with a jacket or a sweater. Our office will be a little colder than you’re accustomed to because of all of the protective equipment that we’re wearing.’ I think that’s a very professional way to communicate chilly information to them.”

There are many valid reasons that cooler temperatures should take precedence in the dental practice.

“Healthcare practices keep the temperature cool, traditionally, to accommodate the clinical team with all their PPE,” Dorst says. “But then there’s another reason for that: The cooler temperatures reduce the potential for microbial growth. If you have a warmer environment, that can encourage bacteria and fungus to grow – not so for viruses, viruses like a cool dry temperature. So, having those lower temperatures is going to reduce microbial growth. Even the humidity is critical for controlling microorganisms. The humidity should be between 40-60%. The reason for that is if it gets lower than 40%, that encourages viruses. Viruses really like a cool, dry environment to multiply in. That’s why winter time is the time of influenza.”

That is not to suggest that there is no room to strike somewhat of a temperature balance between clinical and front office staff.

“One of the biggest things, first, is communication,” Dr Schrubbe says. “Training is key, and this is what we consultants pride ourselves on is educating people, training them, and communicating well with the team. First, get that team together and say, ‘OK we have to come to some decision on the temperature in here, because I’ve heard stories where people actually say, ‘The thermostat is supposed to be set at, XYZ degrees and Sue, who is always warm, is constantly sneaking over and changing the temperature.’ You don’t want to have that happening.”

If the temperature is too cold, there can be performance and safety issues as well.

“Cold air blasting constantly creates issues for muscles and joints,” Dr Schrubbe continues. “At the lower temperatures, muscles lose their heat and that causes them to contract. People can get stiff, and we don’t want that in dentistry, because it could affect our hands, arms and posture which is all vital for the delivery of dental care.”

Summer can be a wonderful time of year, but for team members ensconced in restrictive PPE, the heat can become stifling and overwhelming. However, taking the time to research one’s options can lead to a more productive, comfortable, and efficient summer.

In the heat of summer, it can be hard to stay cool while still maintaining proper infection control protocols. But there are a variety of ways to beat the heat while still keeping clean. 

Keeping Your Cool: How to Work Safely in Warm Weather 

Material Innovations in Same-Day Dentistry Settings and How They Impact Our Daily Practice

CAD/CAM Dentistry, The Biomimetic Way

Achieving Balance With Daily Anterior Direct Restorative Dentistry

A Revolution in the Experience for the Patient and the Clinician

Expanded Applications in Same-Day Dentistry

Same Day Dentistry-Panel Discussion

Videos

Join industry professionals in discovering and learning about the application of technology and techniques in same-day dentistry. 

Same-Day Dentistry Summit: Technologies and Solutions for Quality, Complete Dental Care in a Single Day

Sunbit Technology has introduced its buy now, pay later solution to the dental market. Offering patients the flexibility to pay for dental services over a period of 6, 8, 12, and 24 months, Sunbit’s buy now, pay later (BNPL) program has the ability to serve 85% of patients who apply.

The BNPL program offers access to financing for procedures between $60 and $10,000 and all qualified patients get access to 0% for 6 to 12-month payment plan options. Sunbit manages the application and collections processes and the dental office gets paid right away, increasing cash flow to the business without the risk of a patient defaulting on the loan. A patient’s credit score is said to be unaffected by the application process.

Additionally, Sunbit has also developed practice-focused tools and support to ensure successful implementation. The platform is designed to offer near real-time reporting so practice staff can review their performance at the coordinator, office, or dental service organization level. This includes the number of applications, approval rate, and production earned from Sunbit’s technology.

Practices are also assigned a dedicated success team to ensure that office staff are trained, certified, and continually engaged to take full advantage of the platform.

The company's new financing platform offers patients a range of repayment options from 6 to 24 months.

Sunbit Launches Buy Now, Pay Later Platform for Dental Market

Sterngold Dental has added Transdermal Relief Cream (TRC), a medical grade CBD, transdermal product made to relieve pain and discomfort. It contains 750mg of professional strength CBD in a single tube. TRC has been made specifically for the dental community, tested by dentists. It was created as a pain relief alternative to opioids and painkillers for those with TMD and other pain, according to a press release from Sterngold.

The product is safe and contains no THC and has been tested by both dentists and patients. In can be used in a variety of ways such as jaw joint soreness, extraction, post-operative sensitivity, and other instances which may cause pain in that area.

TRC is available now by authorized distributor Sterngold. To learn more about TRC, visit the website 

Sterngold Dental has added a new holistic, transdermal cream product to help patients with pain and discomfort. 

Sterngold Dental Adds Holistic Relief Cream

SOTA Imaging announced the launch of Cazoo, an extraoral aerosol evacuator that was designed to reduce dental aerosols. This reduction of dental aerosols will protect clinicians and patients from COVID-19 particulates.

Because of current recruitment challenges brought on by COVID-19 safety concerns, Cazoo was designed specifically to safeguard against the virus and mitigate risk for clinicians. It connects directly to high-volume evacuator (HVE) line, as 

 conducted independently shows a significant reduction of particulates when compared to intraoral standard saliva ejectors.

Cazoo is applied with a lip attachment or to a cheek retractor, and a splash guard sold separately is said to provide additional protection from aerosols. Practitioners can also purchase the arm accessory for precision and two-hand dentistry/hygiene procedures.

This extraoral aerosol evacuator was designed to protect from dangerous COVID-19 particulates transmitted through aerosols.

SOTA Imaging Launches Extraoral Aerosol Evacuator Cazoo

Dental insurance and patient billing service, eAssist Dental Solutions has added the Practice Booster and Coding with Confidence line of products to its dental office support service suite.

Dr Roy Shelbourne will serve as the new director of Practice Booster while the entire Practice Booster team, including Dr Charles Blair, will be affiliated with all services offered by eAssist. This includes Practice Booster, Coding with Confidence, and Dr Charles Blair & Associates products and services.

Practice Booster newsletters and resources will be published by the new eAssist Publishing division to provide billing, coding, and implementation tips. These are said to lead to maximum reimbursement from insurance carriers while mitigating risk, according to a press release from eAssist Dental Solutions. 

This acquisition will allow eAssist to further develop Practice Booster tools as well as expand its line of resources.

This acquisition will allow eAssist to further offer resources and sources for its billing, coding, and administrative support suite. 

eAssist Dental Solutions Acquires Dr Charles Blair & Associates, Practice Booster, and Coding with Confidence

The dental service organization Sage Dental announced its partnership with dental artificial intelligence (AI) service Pearl. This partnership will allow Sage Dental to utilize Pearl’s AI insight for patient care across 70 offices in Florida and Georgia.

AI-detected evidence will be analyzed through patient radiographs and then compared through treatment data in practice management systems. It then compiles results into insights for best patient care procedures, according to a press release from Sage Dental.

This partnership is said to support treatment and workflows through empirical data and the AI is meant to boost efficiency, accuracy, and consistency for the best patient outcomes.

This partnership will bring Pearl’s artificial intelligence to help patients receive the best treatment and outcomes. 

Sage Dental Partners with Pearl to Offer Artificial Intelligence Clinical Care to Patients

The Dental Compliance Institute (DCI) has published a “How to Survive a Surprise OSHA Audit” guide that is meant to help dental practices prepare for unexpected audits by keeping them up to date on OSHA regulations, according to a press release from the company.

Because of the change in OSHA regulations over the past year, dental professionals are invited to brush up on their OSHA knowledge to avoid compliance fees and health and safety risks through the free guide provided.

DCI will be providing a series of guides with topics including HIPAA and risk management in the coming months. The “survival” guides will be available to download.

The “How to Survive a Surprise OSHA Audit,” guide will be available for free and is the first in a planned series of survival guides. 

Dental Compliance Institute Publishes OSHA Audit Guide

Orthodontic corporation Ormco has announced U.S. Food and Drug Administration (FDA) clearance for the use of its Spark

 Clear Aligner System for treatment in younger patients.

Spark Clear aligners are designed for kids and teens with cases varying from simple to complex and are said to be comfortable and more stain resistant, according to a press release from Ormco. Spark Aligners are made with TruGEN

, a clear material that resists stains. Its edges are smoothed to offer a more comfortable experience for wearers.

Spark Aligners involve the doctor directly and can be used to treat a variety of issues that may bother teens and kids. The FDA has cleared it for use in the U.S.

The clear aligner system has been cleared for primary and secondary teeth treatment for younger patients. 

SOTA Imaging Launches Extraoral Aerosol Evacuator Cazoo

eAssist Dental Solutions Acquires Dr Charles Blair & Associates, Practice Booster, and Coding with Confidence

Sage Dental Partners with Pearl to Offer Artificial Intelligence Clinical Care to Patients

Dental Compliance Institute Publishes OSHA Audit Guide

Spark Clear Aligner System Receives FDA Clearance for Younger Patients