Lisa Newburger, a master's level social worker supervisor, helps audiences find humor in talking about tough topics. Her "in-your-face" style of presentations and writing will make you smile or just shock you into taking some action. Either way, she is very effective at empowering others to reach their goals and feel better about themselves. Her entertaining workshops are available for national and international audiences. Writing for the dental industry since 2010, she uses an alterego (Diana Directive) to illustrate her points in a sarcastic but effective way. Presentations can be scheduled by contacting Lisa at www.discussdirectives.com/dental.html.

Dear Dental Hygienists: Isn't it Time to Value Ourselves Properly? Photo courtesy of JackF / stock.adobe.com

The time has come to talk about something many of you have been pondering behind closed doors. You might be too afraid to say it out loud. Instead of judging, give some thought to the idea you are about to read.

As you know, there is an immense shortage of dental hygienists, front office staff, and dental assistants. My message is this: It’s time to charge forward and get raises for the hard work that you are doing. Why not?

‘Why not?’ is a loaded question, but there is nothing wrong with looking out for yourself. If you feel that you have not been compensated appropriately in the past, then do something. Look at any of the dental Facebook pages, and you will repeatedly see the need for staff. From sign-on bonuses to fantastic compensation, this is your time.

I hope I am not going to get flak from some of you thinking I am fanning the flames. Some may think this is unethical to be thinking about oneself during a pandemic. My response to them is, “Nonsense.” People have a right to feel empowered and to change their lives. I am merely pointing out that now may be the time to act. The catalyst may be the pandemic and all the problems that have come with it, but with problems come opportunities. You are being given permission to think about yourself. I can hear the dentists beginning to roar and share their feelings on this issue.

Please don’t get me wrong. I am not saying that you should gouge your boss to either pay you more money or leave. What I am saying is that you are in a different position right now. You are a desired commodity. Society doesn’t yet realize how difficult it is going to be to get their teeth cleaned, but they will shortly. With fewer hygienists graduating, the talent pool isn’t growing. Now you can advocate for yourself. What would make you happy? What is realistic? What is crossing the line and being selfish and asking too much?

I’m not focusing on money. Instead, for some, the goal is to get more respect as a professional. You are in a position of power now, but with power comes responsibility. You can’t just go off and demand the world to be laid at your feet, but you can affect change. You can affect how your profession is viewed. You can affect how the culture in your practice can be. Change is a good thing. It provides an opportunity for improvement.

Some of you will realize that you have a good working situation. Maybe you just want to be included in the decision making. Sometimes you need to know more about what the bigger picture looks like. Then, you can decide how to approach your office manager or dentist.

I am not writing this to stir things up (wait a second…maybe I am). When you get passionate about something for or against it, let’s face it, it doesn’t matter. It gets you thinking. It gets you talking. Communication and critical thinking are what propels further changes and improvement. Ultimately, you must do what you think is right, but don’t look back at this unique time in history and remember that you did nothing and regret it.

 and share what you think about this article. Isn’t it time?

Articles

As a dental hygienist, it is important to understand your value in the practice, especially now as shortages cause staffing issues. 

Dear Dental Hygienists: Isn’t it Time to Value Ourselves Properly?

PostProcess Resin Removal Solution Now Compatible with Carbon DPR 10

PostProcess’s Resin Removal Solution is now compatible with Carbon DPR 10. Carbon DPR 10 is a material that can be used in dental and orthodontic model production. Developed specifically for use in the Carbon Ecosystem, the PostProcess®DEMI 910™ is capable of automated resin removal for an entire build platform from a Carbon large-format L1 Printer or 2 build platforms from a Carbon high-resolution M2 Printer.

The system is said to improve productivity for Carbon’s 3D printing systems as well as improving generally usability and efficiency. PostProcess’s PLM-450-SUB is chemically compatible with Carbon DPR 10 resin for an efficient cleaning experience. DEMI 910 and PLM-450-SUB detergents are also compatible with a variety of other Carbon resins.

PostProcess’s VP of Strategic Partnerships Dean VonBank said in a press release, that streamlining processes is the best path to more sustainability and efficiency.

“Like all of our automated 3D post-printing solutions, the DEMI 910 was designed to deliver scalability and efficiency for additive manufacturing users,” VonBank said in the press release. “Expanding our Carbon partnership to include compatibility with DPR 10 means a streamlined and more sustainable process for Carbon customers in the Oral Health and other industries.”

This detergent will help automate resin removal for a more efficient and streamlined post process. 

Midmark Releases Dental Practice Safety eBook

The dental solutions provider Midmark has released an eBook titled “Safety Now More Than Ever.” This eBook analyzes how practice design, equipment, and protocol contribute to better infection control and thus better patient outcomes.

As patients are wary about coming back to the dental practice amidst the COVID-19 pandemic, practices can provide comfort and confidence in infection control protocol. Vice President of Clinical Affairs and Chief Medical Officer of Midmark Thomas Schwieterman, MD, MBA emphasized reassurance in a press release from the company.

“As the pandemic continues to evolve, safety remains a top concern,” Dr Schwieterman said in the press release. “And patients are seeking reassurance that visiting their dentist is safe. Dental professionals who follow best practices for infection prevention and clinical zone safety are differentiating themselves from their peers. To help doctors follow the best practices, we have published an eBook that outlines the latest clinical guidelines and safety protocols to help doctors ensure they are providing their patients the safest means to obtain dental care.”

Notable points in the eBook include safer workflows and clinical environments. The eBook will act as a guide through areas of the practice where infection control must be the highest priority, including the treatment rooms and sterilization center.

Other important notes touched on in the eBook are instrument sterilization and best ways to reduce airborne pathogens. It can be downloaded from Midmark’s website. Midmark dental focuses on utilizing practice design for the best and safest workflows.

This dental practice safety book will position practices to have safe infection control protocol. 

30 Minutes of Therapy Episode 17 - How do we Avoid Burnout?

Videos

Dental practice coach Mike Massotto joins editorial director Noah Levine for 30 minutes of practice help and advice. In this episode, Mike and Noah discuss how to appreciate staff and help avoid burnout. 

MicroCare has announced its acquisition of Certol International. Certol is a cleaning and disinfecting products manufacturer, including a line of Environmental Protection Agency (EPA) registered surface disinfectants.

These specialty cleaners are designed with medical facilities in mind, making them a good fit for dental offices. MicroCare CEO Tom Tattersall said that this acquisition was a great opportunity to provide a myriad of cleaning solutions for customers.

“Certol is a perfect fit to our approach of providing a full spectrum of critical cleaning options to our customers,” Tattersall said in a press release from the company. By combining our two organizations’ quality products, brands and global distribution capabilities, MicroCare and Certol can provide customers with an expanded product selection, faster delivery and optimal customer service.”

MicroCare is a company that formulates medical grade, critical cleaning solutions. Along with that, MicroCare also offers on-site audits, product recommendations, and safety trainings for staff and facilities.

MicroCare’s acquisition of Certol will make more cleaners and disinfectants available to dental practices. 

MicroCare Acquires Certol International 

Stan Goff is the Managing Editor of Dental Products Report, Dental Lab Products and Modern Hygienist. He has covered the dental industry since 1999 and can be reached at sgoff@mjhlifesciences.com.  

Advances in materials and technologies have dramatically changed the way dental laboratories operate. Milling machines, scanners, 3D printers, and the realm of materials used with them, are offering new approaches to familiar challenges, and new levels of accuracy and efficiency for everyday processes.

With these new systems and materials comes a whole new way of doing things in terms of workflows and capabilities that totally reshape what a dental lab can look like. One way to put these innovations in the spotlight is to take a look at what they replaced. It’s easy to get used to a comfortable and effective daily workflow, and sometimes it may even seem there’s no need for change. But once something new is brought to the lab world designed to save time, enhance results, or otherwise make things better, it’s easy to move forward from the way things were.

This article (and its online components at dentalproductsreport.com) puts some of those former favorites front and center a final time, as dental laboratory professionals share stories of things they once used day in and day out but no longer need due to innovations that make practicing dentistry better for everyone.

Today, the shift to monolithic zirconia solutions is complete. The latest advancements in zirconia production are now combining strength and esthetics.

Alloy to Zirconia … the Products We Left Behind!  

The author's choice for the new product that will help transcend the dental lab  industry is the Ivotion system by Ivoclar Vivadent.

Ivotion, the Preferred Digital Denture System


Metal free restorative materials and digital dentures have changed the way dental labs work with clinicians and has opened up a whole new set of workflows.


The Dental Lab Products We’ve Left Behind (and What’s Replaced Them)

Vista Apex Launches Vista Apex U eLearning Platform

Vista Apex has announced the launch of its new eLearning platform titled Vista Apex U. It plans to be a free, online platform that will offer continuing education credits to dental professionals. They are doing so as an AGD Pace accredited provider.

Courses will cover a variety of topics relevant to the dental profession today including restorative procedures, endodontic procedures, and other important procedural protocol in the practice. Lecturers include Mike DiTolla, DDS, FAGD, John Kanca, DMD, and Rico Short, DMD, among others. These instructors will be able to provide industry insight and unique learning opportunities for those who attend Vista Apex U, according to a press release from Vista Apex.

CDO of Vista Apex Michael Miyasaki, DDS said that education needs to be patient focused, as well as keeping up with modern innovations.

“At Vista Apex education and innovation are the bedrock of our foundation. We’re always learning and improving and now we can provide those same opportunities to the clinicians we serve too,” Dr Miyasaki said in the press release. “Dentistry is an ever-evolving practice, there are always better techniques discovered and better materials formulated to give our patients the best treatment possible.”

The platform is said to be easy to use and free for clinicians looking for a continuing education experience that won’t break the bank.

This eLearning platform will offer free courses for clinicians wishing to bolster their endodontic or restorative skillset. 	

Phil Bride is deeply experienced in building successful teams and organizations. With over 30 years of business growth and development experience, he guides teams through the next stages of their business journey.

Prior to joining the Fortune Management team, Bride built and managed multiple companies from the ground up. He owns a consulting firm, Fortune Management NW, that specializes in assisting practices throughout their growth journey. his coaching approach utilizes business skill development, tracking progress, guiding strategic directions, team training, and executive coaching to help business owners develop, focus on, and accomplish worthy goals.

Bride earned his master of business administration and bachelor of science degrees from the University of Portland. He was previously the president of the international business intelligence company JRI which provided key performance indicator tools for developing businesses. He has also developed teams in the US, Canada, Europe, and Asia. He is certified in professional assessments (DISC, AI).

Bride’s years of experience and approach to coaching teams have created environments of growth in his clients. He focuses on the continued growth and improvements of all 5 business engines in a dental practice.

Contact Bride today to get started at 503-753-9971. You can also learn more about him at 

A powerful culture is built one person at a time. However, it takes buy-in from each person to become a reality.

"Everything is fine," I hear the dental assistant say as I look around the room during a team meeting. The response was after asking the group, "How have things been going?"

"Uh oh," I think. “Everything is fine” are the 3 most telling words indicating I'm dealing with dysfunctional team and a weak culture.

I ask, "What makes this place a great place to work?" Arms cross and people don't make eye contact. One person blurts out, "The patients. We love our patients." Then, "Yes, the patients are great," and others add in similar comments.

No mention of being part of a great team or excellent teamwork. No mention of the love coming to work or this being the best place ever to work.

"Okay that's good. Something to work with," I say to myself.

From this short exchange, the pent-up frustrations leak out.

The most high-performing teams exist in powerful cultures. Around the country, they experience 30% growth and strong profits, regardless of the state of the economy or the market. Good or poor economic conditions, they get growth from more patients, more per patient visit, and more visits.

Doctors with powerful cultures tend not to be overly involved in daily business administrative activities, freeing them to focus on what’s most important to them. How can this be?

Team members take charge of the various operational activities. They source scheduling, billing and collection, insurance, enrollment, reactivation, patient outreach, patient experience, and more … all with doctor oversight.

Each person on the team has a sense of ownership in the success of the practice. They no longer view their work as a J-O-B. Rather, they become part of a team making a difference.

The practice starts to generate more money whether the doctor is present or not. This is the point of a business: To build wealth even when the doctor is not producing directly. Otherwise, it's only a good job for the doctor.

And the best part is that the doctor feels a newfound confidence that the practice is being well cared for by the team.

If there's no articulated clear plan nor clear lines of execution, the hidden costs start to become not-so-hidden and take their toll on the practice business results and the team.

The cost of a weak culture pervades every business engine. It shows up as less than excellent communication within the team and with patients, during enrollment and in collection. It can lead to patient no shows and cancellations, as well as patients leaving the practice with no feedback.

It leads to lack of recommendations of family and friends.

Imagine one crown a week lost due to communication hiccups! The hidden costs germinate as a poor communication exchange in the scheduling, enrollment, chairside, a handoff or any of 20+ touchpoints that happen during the patient's experience. The hidden costs then come to fruition in lost treatments and lower recare effectiveness rates.

Next, teamwork suffers. It often leads to people keeping their heads down, out of the doctor's way. It progresses to grumbling and subgrouping. It then moves into showing up late for work, leaving early, and longer lunches and breaks. The final stage is leaving the practice to look for something better.

HR groups estimate that the cost of an employee turnover is 1.5x to 3x the annualized salary of the person that quits.

The Number One Obstacle to Create a Powerful Culture

The number one obstacle to create a powerful culture results from leadership skills, not management skills. Leadership is all about developing people. Leadership brings out the best in each person, one person at a time.

It turns out leaders are developed. Anyone can learn these skills.

Every person on the team (the doctor, the front desk, and the clinical staff) all must learn leadership skills to create a powerful culture. The issue is not personality type. Rather, it is a willingness to improve oneself.

Five Steps to Create a Powerful Culture 1 Person at a Time

There is no silver bullet, no magic wand, no "do this one thing and everything will be peachy." Rather, follow these 5 steps and you are on your way to create a powerful culture!

1. Doctor must acknowledge his or her own strengths, weaknesses, talents, and blind spots.

 Understanding these objectively takes the form of an objective evaluation. Then accepting the truths found during the process ... a foundation of leadership.

 These values must pass muster under duress and not change. They have guided and will guide your life and practice. Get them accurate, articulated, and written.

3. Create a clear written vision of where you want to take your practice. 

Then co-create, with the team, a shared vision for the practice.

 You need a wingman or wingwoman who wants the same outcomes as you. They want to get there in the same way by which you want it to happen. This person becomes an influencer, a “keeper of the culture.” Choose wisely.

5. Expand the alignment of values and direction 1 person at a time.

 Invest the time in developing your people. Enable your "keeper of the culture" to develop other keepers of the culture. Stay firm in your commitment to developing your team.

This leads to a powerful culture that can withstand the onslaught of cancellations, chaotic schedules, difficult patients, miscommunications, and insurance issues. It leads to constant and never-ending improvements. People step up in surprising ways.

A powerful culture is never a "one and done" type activity. There are too many daily pressures tugging at it from different directions. It takes constant reinforcement, reminders, training, encouragement, and realignment.

We are talking about leadership to create a powerful culture. Be relentless in this pursuit. It will pay huge dividends.

A powerful culture in the dental practice can withstand the onslaught of cancellations, chaotic schedules, difficult patients, miscommunications, and insurance issues.

Creating a Powerful Culture, 1 Person at a Time

Kristin Hohman has served as Associate Editor of Dental Products report since 2019. She has a background in journalism and digital content. Kristin can be reached at khohman@mjhlifesciences.com.

Just as technology has changed the clinical practice of dentistry, the day-to-day minutiae of running a dental practice have evolved as well. (Mostly) Gone are the days of rifling through paper charts and files, sending appointment reminder postcards, and having patients fill out printed forms.

Those tasks have been replaced with efficient computers and cloud-based systems that can pull up a patient's chart with the click of a button, automatically send patients a reminder text message for their upcoming appointments, and allow patients to fill out forms electronically. 

Not only are these technologies more efficient for the front office staff, but these conveniences have become something patients expect, just like they've come to expect first-class technology in the operatory. And just as the case with clinical technology, not offering these options for your patients may come at the practice's expense.

We're giving these outdated systems the chance to shine 1 last time, the final bow before the curtains close. Then we'll turn our attention to the practice management technologies that replaced them and, in the process, have moved dentistry forward.

Did You Get My Fax?

Computer Storage is Better in the Cloud

We Went Online With Referrals After 20 Years of Paper

Server-Based to Cloud-Based Software

The Practice Management Products We've Left Behind (And What's Replaced Them)

Computers and cloud-based systems have replaced many front office tasks, making dental practices more efficient and convenient for patients.

A conversation with Dental Marketing Strategist Naomi Cooper Hochman and Dental Products Report Managing Editor Stan Goff about the best ways to market your practice in these times. 

Making a Good Impression in the Practice

Since its introduction 2 decades ago, each generation of ProTaper from Dentsply Sirona has stood for a trusted, reliable and predictable preparation method that enables excellent clinical outcomes for patients worldwide. The company now is introducing its latest endodontic system, the ProTaper Ultimate.

With advances in endodontic treatment, dentists enable patients to keep their natural teeth for many years—ideally for a lifetime. This makes it even more important to have a complete set of products that can help ensure treatment success from root canal treatment to restoration.

With ProTaper Ultimate, the company is now introducing a technologically driven fourth generation system. The treatment concept is based on 3 pillars: shaping, 3D cleaning, and filling root canal systems. The standard sequence of the shaping pillar includes 3 file types; namely, slider, shaper and finishers. These feature specific files are designed to safely prepare a full range of endodontic anatomy. Novel auxiliary files are available for larger and straighter canals and all files are available to prepare canals mechanically and/or manually.

The ProTaper Ultimate Solution offers extensive options: The cleaning pillar is focused on eliminating pulp, bacteria, debris, and breaking down products, when present. To facilitate cleaning, a highly flexible, polymer canula with a bifid apical flow channel can safely deliver irrigant deep into the apical portion of the preparation. With a fluid-filled canal, a reagent of the clinician’s choice can be exchanged into both the instrumentable and uninstrumentable portion of the root canal space, utilizing the novel SmartLite Pro EndoActivator, which will be launched in the coming months, according to Dentsply Sirona.

The SmartLite Pro platform offers 3 attachments; namely, the SmartLite Pro curing light, the transilluminator, and the EndoActivator. Finally, the obturation pillar will enable dentists to successfully fill and seal the root canal system thanks to predictable shaping and cleaning. The ProTaper Ultimate Solution also includes dedicated gutta-percha master cones based on the unique Conform Fit concept and technology. Jointly used with a Conform Fit gutta-percha master cone, the new AH Plus

Bioceramic Sealer will help ensure filling root canal systems where the sealer bonds to the cleaned dentin walls to ensure healing.

“From its inception so many years ago, our thinking has always been continuous improvement,” says Santa Barbara, California endodontist Clifford Ruddle, one of the inventors of ProTaper Ultimate. “ProTaper Ultimate has been designed to provide confidence and predictability for the clinician and patient alike. This comprehensive file system balances safety and efficiency when preparing canals that range from easy and straightforward, to large and open, or that exhibit challenging curvatures and recurvatures.”

“In endodontics, the files themselves have primarily set the agenda in the past,” explains Greg Sheehan, Vice President Global Endodontics Procedure at Dentsply Sirona. “With the ProTaper Ultimate Solution, we are now focusing more on the entire treatment process, in which all steps and details are precisely coordinated with each other. This simplifies the treatment itself, saves time and gives the user certainty that each procedural step will be implemented successfully.”

ProTaper Ultimate, Conform Fit master cones, and AH Plus Bioceramic Sealer are available beginning September 2021 in the United States and following in other countries as per local registration time.

Clinical education is paramount to empowering dental professionals to provide the best possible care to their patients, and the company’s extended program will combine product demonstrations and experiences from experts from all over the world. Dentsply Sirona World 2021, later this month in Las Vegas, offers engaging and dynamic speakers, educational sessions, networking opportunities, health and wellness sessions and educational webinars and more.

As a complete solution, the ProTaper Ultimate Solution comes with files, absorbent points, Conform Fit gutta-percha master cones, and is jointly launched with a next generation sealer, the AH Plus Bioceramic Sealer.

ProTaper Ultimate is the Latest Endo Solution Offered by Dentsply Sirona

Dental Products Report Teams Up with Greater New York Dental Meeting. 

(DPR) has announced a partnership with the Greater New York Dental Meeting taking place November 28, 2021-December 1, 2021. The Greater New York Dental Meeting will host a product showcase to show off and demonstrate the types of cutting-edge innovations that are often the subject of Dental Product Report’s online and print content.

This event will provide educational opportunities ranging from half- and full-day seminars, workshops, and live product demonstrations for dental professionals. The meeting will also feature the World Implant Expo, the Annual Global Orthodontic Conference, a 3D printing conference, an Oral Health Symposium a Pediatric Summit, the Women’s Program, and Dental Laboratory Education.

Vice President of Healthcare at MJH Life Sciences

, Eric Temple-Morris said that this was an opportunity professionals will not want to miss out on.

"In partnership with Greater New York Dental Meeting, this event is an amazing opportunity to display the numerous educational offerings of the product showcase theater," Temple-Morris said in a press release. "We urge all interested vendors to take advantage of this incredible chance to demonstrate their talent while simultaneously learning from some of the top professionals in the dentistry industry."

DPR will lead 8 demonstrations sessions with continuing education credit on each day of the meeting, available on a first come first-served basis. Preregistration is free and available now.

Dental Products Report Teams Up with Greater New York Dental Meeting 

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.

Chill Out: Managing Infection Control in the Heat. Photo courtesy of Framestock / stock.adobe.com

Last week, my wife was getting ready for a dental appointment, and she said, “It’s hot outside, but I’m going to bring a sweatshirt, because they always keep it so cold.”

“There’s a good reason for that,” Karen Daw, “The OSHA Lady”, speaker and consultant, later told me. “Team members wear so much personal protective equipment (PPE) that they have to keep the air conditioning turned up to keep themselves comfortable.”

In the summer months, practices must contend with several environmental challenges – including heat, humidity, and air quality – to keep themselves comfortable and their patients safe.

Finding the temperature that’s right for everyone – clinical staff, front desk staff, and patients – can be somewhat of a juggling act.

“What can we do to make the clinical team comfortable,” Daw says. “And 1 of the first things I like to suggest is, can we make it cooler in the office, in general? And then I get team members saying, ‘But, the doctor doesn’t want it too cool, because the patients complain. What can we do to resolve that?’ Why don’t we manage expectations? What if, during the text, email or phone confirmation, we let our patients know, ‘Hi, Mr. Smith, we’re looking forward to having you back in our office for your dental cleaning, and by the way, we’re following the high standards of safety in our practice for your benefit and the benefit of our team members. As a result, you may notice it a little bit cooler in our practice than you’re used to. So, we’re recommending to just bring a light jacket for your appointment.’ What if we did that? And then we could make everyone happy and we’re managing those expectations ahead of time.”

PPE exists to keep everyone safe, but that equipment can become uncomfortable and potentially hazardous to use in warmer temperatures.

“If your goggles are fogging up when you’re wearing a mask, it means that your exhalation air is escaping. Be sure to crimp the nose band of your mask securely” infection control consultant and speaker Leslie Canham, CDA, RDA, says. “I know, for myself, if my N95 respirator is not sealed properly around my nose, when I exhale, my regular glasses fog up. This means that my PPE doesn’t fit well.

“Many times,” she continues, “we have 3 people in a treatment room – the dentist, an assistant, and the patient – and they’re all in close proximity to one another. In addition, an overhead light may give off a little heat, as well.”

PPE does not need be stifling. Team members can still wear appropriate PPE with an element of comfort in mind.

“You can wear blue jeans and a t-shirt for all OSHA is concerned,” Daw says. “It doesn’t matter, because you’re putting on PPE over them once you get into the workplace. That PPE cannot leave the workplace. So, what can you wear underneath it? Do you 

 to wear scrubs underneath it? I know of dental offices that have gone with the scrub pants, but as far as the top goes, they switched to wicking runner tops, for example – something that kind of wicks away moisture from the body and helps to regulate your temperature a little bit more, so that it is a little bit more comfortable underneath that gown and other PPE. It doesn’t matter what you have on underneath that, as long as your PPE on the outside protects your skin and the clothing underneath from contamination or exposure.”

Ensuring that team members are comfortable is an important consideration, but there are safety concerns that go hand-in-hand with the right temperature.

“It can present a problem when temperature is crucial in certain circumstances,” Canham observes. “For example, some dental materials are adversely affected by temperature.”

Further, some PPE is impacted by environmental extremes.

“Exam gloves, and other disposable items, can be affected by heat and humidity,” Canham says. “It’s a good idea to store these items, especially exam gloves, away from extreme heat, direct sunlight, or sterilizers. For example, the steam from an autoclave can cause damage.”

Team member wellbeing is important not just from a comfort standpoint, but also as a safety concern.

“You add the extra steps of extra physical exertion, along with the extra PPE, and we have team members who are really getting hot and at risk,” Daw observes. “They might not be as attentive or they’re just uncomfortable. And when they’re not comfortable or if they’re sweating all over the place, then their minds are elsewhere. ‘Gosh, I am just super hot.’ We could, potentially, be at increased risk for injury in the workplace. What can we do to make our team members comfortable? Because certainly, if it’s too warm, it could increase the possibility that somebody might stick themselves with contaminated instruments or they might skip a step in infection control, because their mind is not on the task at hand.”

It’s also valuable to build some breaks into team members’ days.

“My recommendation is to take breathing breaks from your PPE throughout the work shift,” Canham advises. “Stay hydrated and perhaps even stock up in the staff lounge refrigerator with some electrolyte drinks to replenish if you are getting dehydrated during your workday.”

“A good work practice control might be to give your team members breaks,” Daw adds. “Maybe a little bit more frequent breaks, especially if they’re wearing N95s and you’re breathing through a filtering facepiece respirator all day. And just being mindful of, ‘What can we do to make our team members comfortable’.”

Air quality concerns are also important considerations. Between SARS CoV-2 (the virus that causes COVID-19) and the effects of wildfires, practices find themselves ensuring that the air is safe to breathe. Some may opt to use a fan to circulate air. For some, the use of a fan may be confusing.

“A common question I get is whether or not fans are allowed in the operatory because of the concern around aerosols,” Daw says. “And what’s interesting is that I have not found anything specific by the Centers for Disease Control (CDC) or OSHA that specifically states that you cannot have a fan. A lot of our team members use fans so they can stay cooler. And there’s no actual infection control literature that says, ‘No, you can’t do it.’ It could circulate aerosols, and therefore, may be discouraged, but and there is nothing that outright prevents it.”

Where the fan is placed does matter, especially as infection prevention is concerned.

“With SARS-CoV-2, air movement must be in a clean to less-clean direction, to reduce the distribution of contaminants,” Canham says. “The CDC recommends the use of air purifiers, or portable high-efficiency, particulate absorbing air filtration systems – or HEPA filters – while patients are undergoing treatment. I purchased an air purifier for my home, and I found that it does help cool my room. CDC highly recommends that you consult with your heating, ventilation, and air conditioning system technologist or consultant to help you understand clinical air flow patterns and determine air changes per hour. In addition, they can investigate increasing filtration efficiency to the highest level compatible with the HVAC system, without significant deviation from designed airflow, and investigate the ability to safely increase the percentage of outdoor air supplied through the HVAC system. Ultimately, a properly functioning HVAC system can provide safer air quality and be very helpful for maintaining a more comfortable temperature.”

HEPA air filtration units don’t have to be just be located in treatment areas.

“I like to see them in the reception room of a dental practice. I believe that it conveys a strong message to the patient about infection prevention and safety,” Canham says. “With SARS-CoV-2 being an aerosol transmissible virus, patients understand that we care about their safety in the reception room as much as we care about their safety in the treatment chair.”

Proper environmental levels in the dental practice are certainly important, but not just from a comfort standpoint. PPE, chemicals, and equipment need the right levels of heat and humidity to work properly. That’s not to negate the importance of comfort. Team members work better when they’re not distressed, and they’re less likely to make potentially hazardous mistakes.

Keeping both patients and employees comfortable in a practice while still maintaining infection control protocol is possible.  

Chill Out: Managing Infection Control in the Heat

Among their other techniques, magicians use misdirection as a way to pull off their tricks. By sidetracking the audience with a distraction, they conceal their true actions, but the opposite should happen in the dental practice, especially where infection prevention is concerned. It is best for patients to see exactly what team members are doing to keep them out of harm’s way.

Magicians and dental team members share something important – what’s going on with their hands. Magicians go to great lengths to conceal what they’re doing, but team members want their patients to see exactly what is going on.

“One thing we’ve always said is that hand-washing is always good,” Shannon Mills, DDS, says. 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. “Even if you wash your hands right down the hall, you wash your hands for the full 20 seconds before you walk in the door, you should wash your hands again or use and alcohol hand sanitizer, because patients want to know that you’re doing that. They’ve heard over and over and over again how important that is as an element of infection prevention. I think they want to see you [do that].”

Patients should also see the clinician putting on gloves, so that they know they are safe and protected.

“You never want to walk into the operatory with your gloves already on,” infection prevention consultant Katherine Schrubbe, RDH, BS, MEd, PhD. says. “I don’t because the patient has no clue. Even when you do everything appropriately to pre-glove, the patient doesn’t know that, and hand hygiene is still considered the single most important thing for reducing the risk of transmission of organisms from operator-to-patient, patient-to-operator, and patient-to-patient – all of those could be possible routes of transmission from your hands.”

“You don’t want to walk in with a pair of gloves on, because how do they know that you didn’t go to see another patient with those gloves on,” Dr Mills adds. “They want to see you putting on a fresh pair of gloves or know that you’re doing that just for them.”

Hand hygiene may be Infection Control 101, but a refresher is always helpful.

“If you are using soap and water, wash your hands for at least 20 seconds,” Dr Schrubbe says. “Twenty seconds isn’t that long, you can sing happy birthday to yourself twice, then dry your hands and glove. If you’re using an alcohol-based hand sanitizer, then rub your hands together until the product is used up, let the patients see that you are doing your hand hygiene.”

Magicians also rely on their top hats, specially made clothes, and capes as a part of their act. Likewise, the dental team utilizes personal protective equipment (PPE) for safety.

“Wearing your PPE correctly and letting the patients see that can make an excellent impression,” Dr Schrubbe says. “Wearing your mask appropriately--not under your chin--and wearing your eye protection appropriately when you’re taking care of the patients promotes a culture of safety. Because now, especially with COVID-19, patients are very savvy. I just read an article where a Senator in Connecticut literally left the dental office because he didn’t feel as though infection control was a top priority.”

Patients are more knowledgeable now than ever before, and they want to see their dental professionals doing the right things.

“People want to see that you are wearing the right PPE,” Dr Mills says. “They watch TV. They see what people are wearing, and if you’re not, they may wonder why not. In other words, if you’re not wearing eye protection, if you’re not wearing a proper mask and face shield, they want to know, ‘Why is my doctor not doing what people say health care workers are doing now?’ So, just within reason you need to be doing that.”

Something else that magicians and dentists have in common are their use of tools. Famously, magicians use magic wands, handcuffs, and trick locks. Dentists, on the other hand, use their own specialized tools and equipment, and patients need to know that those instruments are safe.

“Opening instrument packages in front of the patient is vital,” Dr Schrubbe says. “When I do trainings and consulting for practices, I always tell the team that I understand infection control takes dedication to maintaining standards, and commitment to set guidelines and best practices is a lot of work. So, you’ve taken all this time and work to prep those instruments correctly, do the steps for disinfection and sterilization, and now you are in front of the patient. The best thing you can do is crack open that package in front of them and say something – say anything. Say, ‘We take infection control very seriously here. All our instruments are processed and sterilized according to CDC guidelines.’ Let the patient know the work and effort that goes into providing that sterile package to the patient.”

While the best thing to do is open instruments packages in front of the patient, sometimes that may not be possible. If that’s the case, finding a way to convey that message of sterility is important.

“If you open the packages of instruments in front of them, they know that they’ve been sterilized,” Dr Mills says. “But on the other hand, sometimes it’s OK. Sometimes it takes a bit of rigmarole to set that up. I think they should know that that tray, that instrument set, was set up just for them. I don’t think you actually have to open the packages right in front of the patient, because you also have to maintain some level of efficiency and get things set up. On the other hand, you don’t want them walking down the hallway, looking at every operatory and seeing that every empty operatory has the same instrument set up tray set up, already sitting there and who knows how long it’s there?”

Nobody actually believes that the magician’s assistant gets sawed in half. To convey that illusion, there’s a lot hidden that is going on behind the scenes. Likewise, there still exists some things that patients don’t need to see. For instance, if they want to see what’s going on in the sterilization center, it may not be feasible to bring them back there, especially from a safety standpoint.

“The biggest problem I see is that patients would then have to be in full PPE,” Dr Schrubbe observes. “You can’t just bring somebody into your central sterile area – not that it wouldn’t be great for patients to observe the process and what it takes to get that sterile pack to that operatory – but then they would be required to be in PPE appropriate for reprocessing instruments. And even if they are just observing, there are safety issues to pay attention to because the area has chemicals, and contaminated sharps, which require certain PPE and specialized equipment.”

But, if they do see the sterilization area, make sure that it is presentable.

“As long as their sterilization area looks clean, well-organized and sanitary,” Dr Mills says. “You don’t want them to walk by your instrument processing area and see piles of bloody gauze or dirty instruments sitting on the countertop. They want to see things that are clean and reassuring. So, if your sterilization area, for example, is visible to people, you want to make sure that it’s visible in a way that you would want them to see. And if possible, I don’t think people need to routinely see that.

“I think it’s OK to give the new patient that tour, but make sure the place looks great when you show it to them,” he continues. “The main thing is that you want it to be clean. You want your floors to be clean. You don’t want them to walk in and see that the last patient who had a tooth pulled, or whatever, dribble blood on the floor and you didn’t clean it up. Another example is the waste cans in the treatment room. They should be covered. You don’t want them looking in dirty waste cans.”

Seeing the actual activities of infection control is certainly important but conveying an overall message of safety and professionalism also goes a long way.

“I want to make sure that the patients know that infection control concerns are on everybody’s mind,” Dr Mills says. “We want you to know that we’re fully compliant. You can have a sign up [front] that we fully comply with current CDC guidelines. My family dentist proudly shows her OSAP membership placard in her office. The practice wants people to know that they’re very concerned about your safety, that your safety is their first concern, more than anything else. And then, after that, everything follows. If you don’t take care of people’s safety while being at the dentist, then what else matters?”

Magicians and dentists share many similarities, but where magicians want to hide what they are doing from the audience, dentists should want their patients to see everything that they’re doing, especially because it reinforces their message of safety and professionalism.

Patients should be able to see certain aspects of infection control so that they may feel comfortable and confident in their practice’s hygiene protocol. 

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Performative Infection Control: What You Should (and Shouldn’t) Let Patients See

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