Dr. John Flucke is in private practice in Lee’s Summit, Mo. He also serves as technology editor for Dental Products Report magazine and keeps an active blog filled with thoughts and tidbits on the world of technology at blog.denticle.com.

Dr. John Flucke

Let’s face it, there is no perfect system. As I’ve said many times, striving for perfection is admirable.

It’s what we as health care specialists are challenged to do on a daily basis. However, expecting or demanding perfection is the definition of insanity. No matter how good the systems, the Second Law of Thermodynamics states that things naturally tend to go from order to disorder.

You may think that improvements in our processes and workflows naturally have the ability to eliminate problems we’ve dealt with in the past. But you cannot routinely count on technologies to solve problems that we cannot solve on our own. For example, I’ve had people tell me they were investing in a digital impression system because they “wanted their preps to be better.” While seeing your preps magnified x30 on the screen can help you identify areas that need improvement before milling or sending the scan to a laboratory, simply thinking a digital scan will improve things with no effort on your part is a fallacy.

Don’t get me wrong. Technology can do incredible things for your practice. It can make you a much better operator. However, it will not fix your mistakes. It will just help you make mistakes faster.

As Technology Evangelist, my mission is to push the envelope, find what is possible, and then report to you my discoveries. There are so many amazing technological advancements available to the profession today that it can be daunting to keep up with them. For this month’s article, let’s explore ways we can use technologies currently on the market to improve clinical outcomes for our patients.

Since we first used CEREC in the 1980s, digital impression systems have come a long way. It’s incredible to me when I think back and consider what progress has been made. 

I started my journey into digital impressions in the late 1990s with CEREC 2, which booted the machine…wait for it…with a floppy disk! The images were shown on the monochrome screen in 1 dimension. The mill used a diamond cylinder and diamond wheel to fabricate the restoration. The camera took individual pictures that were captured by pressing a foot switch. When you consider where we are today, it’s a wonder that it was ever considered “state of the art,” but it was.

At that point in time, the acquisition unit and the mill were both contained within the same unit. While sometimes it was good for marketing for patients to watch the machine working, separating the units in the next generation, CEREC 3, was a better idea.

I remember discussing with engineers at Sirona Dental Systems the possibility of sending data to a lab for fabrication of the restorations. I knew there would be some doctors who didn’t want to learn how to design, and there would be cases better off in the hands of a human being. Unfortunately, the technology of the late 1990s and very early 2000s wouldn’t support that dream. There simply wasn’t a readily available high-speed data connection that could send files of the size the machine generated. Sending a crown would have taken hours, if it could have been sent at all.

Now with the proliferation of high-speed data connections, almost every office can send a digital scan in just a few minutes. This has several advantages over analog impression systems. Scans can be delivered to a lab so quickly that the doctor can call the lab and discuss complicated cases while the patient is still in the chair. This results in better communication with the lab techs, and then better results for the patients. It also allows preparation refinements recommended by the lab tech to be made and sent out during the same appointment, which means that patients don’t have to return to have the prep refined. It’s a tremendous time saver for the practice and the patient.

Seating appointments also are much less stressful. Current digital impression systems are so accurate that it is rare to spend a lot of time adjusting. In fact, in my office we have come to expect that the actual adjustment time (if any is needed) to be 5 minutes or less. This helps keep the schedule running smoothly and patients happy.

For anyone who owns a digital impression system or is thinking of purchasing one, I highly recommend a diode laser. While retraction cord is still a viable option in fixed prosthetics, diode lasers are faster, easier, kinder to the tissue, and more reliable when it comes to eliminating problems with retraction.

One of the problems with retraction cord is that the moment you pull the cord, the tissue naturally begins to rebound to its original state. This always throws the team into a game of “Beat the Clock” to either fill the void with impression material or scan the area before the tissue rebounds sufficiently to close off the margin. This can especially be problematic in multiple unit cases. If you are using traditional analog impression techniques, 1 bubble on the margin means you are right back to square 1, packing cord, wasting time, and then playing round 2 of “Beat the Clock.” Some operators choose to use a 2-cord technique to help prevent the above scenario, but that is more time, more effort, and still not guaranteed to rectify the situation.

Because a diode laser ablates the tissue, there is no rebound. That means there is no clock running in your head on how long you have before the potential for problems sets in. Multiple units are simple because once exposed, the margins stay exposed until the body rebuilds the tissues that were ablated.

The margins are quickly and easily exposed, usually taking about 1 minute per tooth. The tip on these lasers is between 300 to 400 microns, so they are minimally invasive while still allowing room for impression materials or allowing the digital scanner to see well past the margin. Some doctors feel that deep margins cannot be read by digital scanners, but that isn’t true. Deeper margins are more difficult for the camera to see, due to the need for the camera to have straight line access visually to the margin. Because light travels in a straight line, a laser does a phenomenal job of dealing with these situations. I have yet to come across a margin that our iTero Element scanner cannot read, if properly exposed.

Using lasers leads to almost no post-operative pain for the patient, meaning that even very deep margins that require greater ablation than normal heal uneventfully. Lasers have so many unique ways of solving everyday problems in fixed prosthetics that there is no way I could practice without them.

One negative I sometimes hear about lasers is their cost. However, time savings and quality of treatment are just two of the benefits that come from diode laser usage in everyday dentistry. Lasers have become quite affordable in the last few years. The Picasso diode lasers from AMD (amdlasers.com) are used by many doctors who understand the value of lasers but are not enamored of units with a high price tag. AMD has created a market of high-value hardware for a very reasonable price.

Bonded restorations frequently require troubleshooting. While there are many factors that can contribute to postoperative problems, one of the most common is the curing light.

In an attempt to get better depth of cure and greater procedural efficiency, many companies have increased the power of their lights. This creates the problem of the “double-edged sword.” While the increased power does provide better penetration of the photons, which gives better depth of cure, the increase in power also creates increased heat.

While you cannot overcure a composite, multiple curing cycles with an intense light can cause pulpal tissue to be thermally affected. Many operators, attempting to get the best cure possible, use multiple curing cycles. However, by doing this, the tooth becomes a heatsink, and the pulp absorbs the excess energy. An increase of 5° C can result in pulpal inflammation, which can cause the dreaded post-op sensitivity we all try to avoid.

The best way to avoid this with high-intensity lights is to slow down between curing cycles and give the tooth a chance to cool. However, there are a couple of lights coming to the market that may provide better depth of cure than multiple curing cycles.

PinkWave from Apex Dental Materials (apexdentalmaterials.com/pinkwave) uses an array of multiple LEDs that emit light in four different wavelengths. This gives the PinkWave the ability to cure all photoinitiated materials but with less heat. The device utilizes two types of LEDs to create the standard blue wavelengths needed for light curing, but also uses a pink wavelength and a near-infrared wavelength to provide better depth of cure and less volumetric shrinkage. In addition to lower heat output, less volumetric shrinkage can also decrease cuspal flexure during curing, thus minimizing postop sensitivity.

The device has a white LED so that, in addition to a curing light, the PinkWave also becomes a highly efficient transilluminator. This helps with diagnosing problems such as “cracked tooth syndrome,” as well as recurrent caries and other clinical problems that can be a bit difficult to visualize without transillumination. Having a curing light that doubles as a transilluminator gives doctors a 2-in-1 device that makes practicing more efficient.

Another curing light coming on the market is the Monet from AMD. The Monet is the industry’s first handheld curing laser. Lasers kickstarted the concept of high-speed curing back in the 1990s. Unfortunately, those lasers were huge boxes that required a cart, were noisy, and were incredibly expensive (I paid $8,000 for mine). However, the smart folks at AMD have turned those large boxes into a standard handheld curing footprint…amazing!

Because the Monet is a true laser, the beam is collimated, so it stays focused in a straight line. This allows all the photons generated to be applied to the target. Lasers also are incredibly bright, meaning it better penetrates into the composite. The device provides a depth of cure of 5 to 8 mm, depending on composite shade, with a 3-second cure cycle. Applying the high energy beam for short cycles allows for tremendous curing with minimal heat generation. Restorations can be built up with fewer incremental layers, speeding up procedures. The Monet provides stronger composites and ensures less sensitivity.

Throughout my career, I’ve learned that technology provides incredible tools, along with better and more choices. It is rare for me to find a new device that completely eliminates the need for its older sibling. I may not use the older device very often, but I still find that the toolbox keeps growing. I don’t throw tools away; I just don’t use the older tools as often.

Everything we do in life and in dentistry carries inherent risks. Those risks can be linked to problems, and those problems can be studied and evaluated, then those problems linked to solutions. Technology has allowed us to do incredible things in dentistry, but it will never eliminate problems or miscalculations. However, technology can make rectifying those situations easier and less stressful on both the patient and the team while also improving clinical outcomes. And at the end of the road, that’s what we’re all striving for, right? See you next time!

Articles

Technology can’t eliminate problems or miscalculations, but it can make rectifying those situations easier and help improve clinical outcomes.

Using Dental Technology to Troubleshoot 

I’d be willing to bet that as you read this, almost all of you have gone back to work. Now, work is a relative term. I’ve always told my family that I go “to the office” instead of “to work” because I really 

 what I do. Work always brings to mind the idea of doing something that you don’t like/want to do and that doesn’t apply to me when I’m in my office.

Don’t get me wrong, there are the occasional days when I’d rather own a bait shop, but all in all I cannot think of a better career than being in dentistry. We get to help people, we sometimes get to change lives, we make a decent living, and we are in a sector of healthcare that pretty much still allows us to call our own shots. There are not a lot of our healthcare colleagues that can check all of those boxes.

Of course, one of the other things I truly love about our profession is the constant influx of new science, new ideas, and new devices that arrive on a regular basis. Dentistry is practically on a “creative assembly line” that makes it appear almost as if we are releasing new things as fast as they can be assembled. It has become incredibly difficult to even keep up with the amount of progress that the industry is making. One thing I noticed during the industry shutdown is that instead of stopping and taking time off, dental manufacturers and R&D shops just kept innovating.

That means that now we are going to see a fairly interesting influx of products that have been waiting for their moment of introduction to the profession. Also, some companies looked at the dental landscape and pivoted knowing that, due to COVID-19, the industry will be looking for products to fill niches that didn’t exist in January of 2020.

One of the really admirable things about dentistry is that, for more than 30 years, we have had a tremendous reputation for infection control. In many ways dentistry led the way during the HIV crisis of the mid 1980s. Patients took notice and then began to expect that their dental visits were going to be different than in the past. And by different, I mean better. Infection control became better than any other healthcare visits outside of operating rooms and outpatient surgery centers.

I was barely out of dental school when all of these changes were taking place and there was a time when patients were concerned about our infection control. Some patients asked about sterilization procedures and some even asked to physically see the office autoclave. However those times didn’t last long. Before very long patients realized all of our extra precautions were protecting them and they became raving fans of the profession and all we had done to make things safer for them.

I feel we face a similar situation currently. Of course patients are concerned about their safety, but when patients walk into an office now and see wholesale changes in our infection control protocols, they immediately realize how much effort we are putting into their safety.

Let’s face it, it’s very easy to see full length gowns, face shields, hair covers, and potentially different masks, if your N95s have a different appearance.

The last three months have brought an amazing amount of human ingenuity to bear on the unique problems we face. When the CDC recommended the general public wear some type of cloth face covering, it seemed like everyone here in the Midwest was wearing one in a matter of a few days. Folks with the talent to sew churned out masks in amazing numbers. Currently it’s almost impossible to see someone out and about without some type of custom mask. Here in the Kansas City area, red masks adorned with arrowheads are all the rage (in support of the Super Bowl champions). When you consider the fact that no one had ever made those before, the numbers that appeared seemingly overnight is truly amazing.

The same goes for face shields. In mid-April I was struggling to find a source for them and then suddenly, in what was truly a number of days, they were appearing from a number of companies. The incredible part was that most of those companies had never made face shields for healthcare previously. They created them because they knew there was a need and felt obligated to help healthcare providers who were desperate for a source.

In my case, we were really lucky. I was approached by a local plastics company the week before we reopened that wanted to help. Within a couple of days we had prototypes. However, they wouldn’t fit over our surgical scopes. Working over the weekend, they cranked out enough face shields for my entire clinical team that solved that problem and worked like a charm. They delivered them the morning before the first scheduled patients on May 18.

I’m also currently working with a custom snow ski company that realized it would be pretty easy for them to make face shields. They reached out to me and I’ve been working with some of their prototypes for a couple of days as I write this. Why would a ski company start making face shields? The owner of the company told me he knew there was a shortage and they wanted to help. How awesome is that?

As protocols began to evolve and become known, I knew having and using non-contact thermometers was going to be an important part of the patient intake process. I was still a month out from reopening, but I thought I should probably start to acquire some of the gear I knew I would need.

Donning my mask, I headed down to my local Walgreens. When I walked in the door, one of the helpful associates asked me what I was looking for. When I told her non-contact thermometers she told me, “They would be at the end of aisle nine… if we had any. But don’t waste your time. We haven’t had any for over a week and we have no idea when we will get more.” Needless to say, that was a tad depressing.

I headed home and logged into my Amazon account, only to find basically the same situation. Sold out with no indication of when more would be available.

Fortunately, I happen to own a few diode lasers and one of them is an AMD Lasers Picasso. Because of that, I am on the AMD email list. About a day or so after my fruitless thermometer search, I received an email from AMD. The company was announcing that due to the COVID-19 pandemic, they had made the decision to begin selling a line of personal protective equipment (amdlasers.com/collections/protective-equipment). And one of the products they were selling was non-contact thermometers. I promptly ordered three and they were in my office a few days later. 

Once again a company saw a need in the industry and quickly found a way to serve that need. AMD Lasers had never before sold PPE, but when they saw that the industry was in dire need, they made a decision to help and quickly scaled up to help dental offices find products that even the mighty Amazon was having trouble sourcing.

I’ve always been fascinated and thrilled with innovation. That’s probably why I have always been in love with technology. The innovation surrounding the current pandemic is not only a great sign of the indefatigable human spirit, it’s also incredibly inspiring.

I love the fact that so many people saw the need to help and then did so without a second thought. The pandemic has been terrible on so many levels for so many people. Yet, in the midst of fear, suffering, and loneliness has come hard work, creativity, and caring for others. Problems have been addressed and some even solved by people who only did so because it was “the right thing to do.” I firmly believe we are all called to help one another and I’m proud of those who in so many ways have answered that call.

Innovation surrounding the current pandemic is not only a great sign of the indefatigable human spirit, it’s also incredibly inspiring and we should be proud of those who’ve stepped up to answer the call. 

Where Do We Go from Here?

For now, we see through a glass darkly; but then face to face.” With all apologies to St. Paul, truer words might never have been spoken. As regular readers of this column will know, I love to talk about change in our profession and all the excitement that normally comes with it. Yet, as much as it pains me to say this, sometimes change is not exciting; sometimes it’s scary. This appears to be one of those times.

	We are suddenly seeing massive changes in our profession to keep our patients, our teams, and ourselves as secure as possible from SARS-CoV-2.

	Probably the perfect solution to this would be to simply press “pause” on dentistry and wait for the science to catch up. Unfortunately, the problems our patients trust us to deal with couldn’t care less and won’t wait for the science to catch up. They will continue to wreak havoc on our patients until we can return and get things back under control.

	My office did not reopen until May 18, which meant I had not done an elective procedure for almost 60 days. During the pandemic shut down, I treated emergencies only for that time and had chosen to work alone in an effort to decrease the number of potential exposures and to conserve PPE. I couldn’t even remember how long it had been since I had worked without an assistant. Amazingly enough, I didn’t struggle nearly as much as I had anticipated. Granted, I was only seeing emergencies and only treating as little as possible to get the situation stabilized, but it also made me appreciate how important my dental assistants are to the equation. There is a reason it’s referred to as a “team”-something every doctor needs to remember.

	Now here comes the tricky part. Dentistry is an evidence-based scientific profession, and it tends to attract people who want to see proof. In Dental Products Reports’ recent Technology and Materials Survey, 54.09 percent of respondents classified themselves in the category, “I’m a researcher. I need to see clinical studies, hands-on demos, etc.” That’s a good thing. Our patients definitely do not want someone who is just “winging it.” But that’s the crux of the problem we are currently facing in our profession. We just don’t have enough scientific information to be able to act with steadfast assurance.

	As I type this, the Centers for Disease Control (CDC) has not updated its recommendations for dental treatment since April 27. The American Dental Association has requested that the CDC update its guidance for dental personnel returning to work, but that information appears to be slow in arriving. The current CDC guidelines still encourage the postponement of elective dental procedures, but at least 28 states are now reopening. That means 28 states have cleared dental offices to open again and begin seeing patients for elective procedures. 

(Editor’s Note: The CDC finally released updated recommendations for dental settings on May 19.)

	While I understand the science is lagging in the battle against COVID-19, at some point the specialists in infectious disease and epidemiology will have to take their best shot at this. I cannot say with any degree of certainty, but it’s certainly starting to look like everyone is so concerned about making the wrong recommendations, that no one will make a recommendation at all.

	Because of that, we are approaching three weeks of some offices performing elective procedures and being forced to use a “best guess” scenario.

	As we all either proceed with treating or proceed with getting ready to treat, the question I am hearing the most among dentists is, “What are you doing for infection control?”

	That simple question is an indication of the difficult position we, as doctors, find ourselves in during this pandemic. I was in dental school when Universal Precautions went into effect. That’s obviously been a while, but I don’t remember there being much confusion regarding the changes that were being made.

	On the other hand, the current situation is rife with questions. So, what do we do? First of all, let me say so that everyone knows, I am not an infectious disease expert. I’m going to throw out a few ideas here. I’m doing this as an effort to get us all thinking-look upon it as a discussion we might have at a meeting in the bar after dinner.

	Masks are certainly going to be a major priority. I’d be willing to bet that most of us now know more about masks than we ever expected in our career. N95s are the best option, but you don’t need to be in healthcare to know they are in short supply. There are other versions available from countries outside the U.S., such as the KN95 from China, which are supposed to be identical to the U.S. N95.

	However, with the demand for respirators has come dishonesty. It’s now become known that some masks sold as KN95 are counterfeit. The U.S. had originally approved 80 overseas companies to provide N95-equivalent masks, but then had to prohibit 65 of those companies from selling masks for medical use. This happened after the federal agencies testing these masks had known of the failures for three weeks. When I found out about this I was outraged, and I feel you should be as well. Heaven only knows how many of those masks were used in that three-week span and how many of our medical colleagues had their lives put at risk because of it.

	Many offices plan to ration these high filtration masks until the supply chain stabilizes. This is done by using one high filtration mask per day and then covering it during use with a separate Level 3 mask. The Level 3 masks can be changed as needed throughout the day. At the end of the day the N95 (or KN95) is placed inside of a paper bag and allowed to sit for 5 days. After the five-day span, the CDC considers them ready to wear again.

	Gowns have also become a sought-after item. Whether disposable or reusable is up to the office, but “gowning up” will become a part of standard operating procedures for the foreseeable future. These should be waterproof and should protect underlying garments as much as possible. Some disposable gown manufacturers switched over to making masks due to demand, which has now created a disposable gown shortage.

	    "We are going to have to be even more vigilant about our inventory control. Running out of critical PPE could stop treatment in its tracks.”

	Hair bonnets have been discussed a lot and no one seems to have a really good answer as to whether or not they are needed. The normal “gauze” types certainly won’t prevent virus penetration, but some individuals feel better with them during treatment. Perhaps the best option for those who desire to cover their hair are the good old fashioned shower caps. These are basically a thicker ply plastic bag with elastic. While these would keep viruses out, they will also be very warm for those who choose to wear them.

	Face shields are also a popular option. While the CDC is currently advising either safety glasses, goggles, or a face shield, many are choosing to wear glasses and a face shield. The problem with face shields is that most are not very compatible with magnification. More than 80 percent of doctors are currently wearing some type of magnification and fitting a plastic shield over almost all of them is difficult if not impossible. Adding to the problem is the fact that most wearing magnification also have a light attached to the glasses. This makes the mask even more difficult to fit, while also creating reflection problems as the light bounces off the mask and reflects back into the user’s eyes.

	Then let’s add in the temperature factor. All of this PPE is going to surround us with non-breathable materials. Viruses cannot get in, but the tradeoff is that heat cannot escape. We are going to get very hot. Spending hours wrapped in layers of insulating materials is no one’s idea of a good time.

	Plus, we are going to have to be even more vigilant about our inventory control. Running out of critical PPE could stop treatment in its tracks, meaning we’ll have to be hyper aware of inventory levels. Also, because the supply chain is so out of sync, we can’t just pick up the phone and place an order with the expectation it will arrive in a day or two. We’ll have to scour all available supply channels in an attempt to find items that are in stock and purchase before those items are sold out. This is going to require a careful balancing act that we’ve never had to perform before.

	Is this going to be difficult? Absolutely. However, we’ll get through it. Dentistry may not have faced this kind of challenge before, but we’ve faced challenges in the past and we prevailed. I’m no happier about the current situation than any of you, but as my grandfather used to say, “Son, if it was easy, everyone would be doing it.” Here’s to doing what is NOT easy. See you on the other side. 

Reopening offices is forcing dental practices to discover uncharted terrain.

Through the looking glass, into the unknown

We are in the middle of a healthcare disruption unlike anything many of us have ever seen. This pandemic has been frequently compared to the Spanish Influenza of 1918, however that epidemic took about a year to wreak its havoc, while COVID-19, thanks to the mobility of the world’s population, has propagated in just a few weeks.

	This event caught the world’s healthcare system “flat-footed” and the necessary response has taken what many consider to be an excessive amount of time to create the required pieces to fight it.

	In my time in dentistry, I’ve only seen one situation that is even close to what we are seeing now. I spent the first two years of my dental school education working in the human mouth with no gloves. That seems so shocking to all of us now, but at the time it truly was the standard of care.

	We also did not wear masks and our handpieces were wiped down with surface disinfectant. They never went in a steam autoclave. The only time handpieces were sterilized is if the patient treated had active Hepatitis B-then the handpieces were sent to a nearby hospital for ethylene oxide sterilization.

	And then the world shook. HIV appeared on the scene and it seemed that everything in dentistry changed overnight. I remember sitting in on a mandatory lecture where we were told that going forward gloves and surgical masks were required. Infection control radically changed. There was some initial resistance in the profession, but we adapted. We went through the fire and emerged stronger. The profession became an example to other branches of healthcare for its devotion to infection control.

	We may very well be standing at the precipice of another serious disruption, although at this point it’s a bit hard to make anything but an educated guesses.

	This has been a difficult time for both the world and our proud profession. The past two months have been fraught with rumors, innuendo, and pseudo-science. Yet, lots of true science and research has also been mixed in. The problem has been trying to separate the wheat from the chaff.
	Every day, we’ve been faced with changing policies and suggestions, only to find that the next day the previous ones have been removed and new ones are in place. This has made it extremely difficult for dentistry to get a clear picture of where we fit in and how we can contribute.

	My gut tells me that we will probably come out of this with some changes in PPE. There may be a move to require N-95 masks. However, we’ve been working in masks that do not filter viruses well until now, and we seem to have done just fine. Whether this is the tipping point for change is hard to discern. As Yoda said, “Difficult to see. Always in motion is the future.”

	The other piece of this ever-changing puzzle has been the financial aspect that we have all had to face. At no other time that I’m aware of in modern history has the world been told to “stand down” in the manner that has happened with COVID-19.

	In a post on my blog (blog.denticle.com) that I made in mid-March, I stated:

“Last week, COVID-19 was a topic of discussion and an annoyance. This week, it rocked the world. On Monday, March 16th and Tuesday, March 17th, my office was cranking along at a pace that made me proud. Patient satisfaction was high, employees were happy, and the financial numbers were more than sound. Then there was ‘that huge sucking sound’ that was COVID-19 tearing through the social fabric. On Wednesday, March 18th, everything changed for the office. I was forced to furlough six employees, cut the hours of those who remained, and begin dismantling a schedule that was a snapshot of front office efficiency.”

	As I type this now, my office is a shadow of what it once was. From a staff of 15 employees, I am now down to one. I am going into the office for two half-days to treat emergencies.

	I know that all of you reading this are in the same situation. This pandemic has forced the closure of businesses and created massive unemployment. I just received an email that states unemployment is at more than 17 million (and has risen since), the highest level of joblessness since the Great Depression.

	Stress and anxiety are high because no one has any answers about how this all plays out or when anyone can expect to start earning a living again. In the meantime, we sit sheltered in our homes, and watch our bank accounts drop while simultaneously praying that the toilet paper shortage ends soon.

	So, what can we do to help create a more positive experience out of all of this? Let’s take a look at a few ideas for managing the pandemic and coming out strong.

	I recently received a compliment from a patient whom I was seeing to smooth a sharp edge from a fractured molar. She told me she had a friend who was a patient in another office. The friend had an appointment in a few days and knew that she would need to reschedule. However, when she called, she received a message that the office was closed and was unsure when they would reopen. My patient said her friend would be calling my office when this was all over because we do such a great job of communicating.

	In today’s environment and with all the digital tools at our disposal, there is no excuse to not be engaged with your patient base. We use Weave (getweave.com), although there are other options as well.

	We’ve been reaching out via email and text messages to do our best to help our patients understand how COVID-19 has impacted dentistry and to let them know we are here to take care of them as best we can.

	Also, if you are looking for a way to give back during these difficult times, try contacting your older patients to see if they need someone to run an errand or pick up a prescription at the pharmacy for them. While I know it is risky to go out right now, it is even more risky for our elderly patients, many of whom are immunocompromised.

	Review targets and know where you are aiming

	Many of us take time over the holiday break to make plans for the upcoming year. That’s a great idea that I highly recommend, but who says you can only set goals around the new year? The downtime we all have right now is the perfect time to set goals if you have not already. If you HAVE set goals for the New Year, now is the perfect time to re-evaluate those goals.

	Until the economy came crashing down, we were in one of the greatest economic upswings in history. That meant many of us were incredibly busy and with busyness comes entropy. Things naturally progress from order to disorder and it’s difficult to stay on top of goals and projects when you are busier than ever before.

	Now is the ideal time to look at what you had planned and see how your goals are progressing. Sometimes you need to make corrections to stay on target. Evaluate things now and make those needed corrections. Then when we get the green light to go back to work, you and the team will be ready.

	If everything is where you want it to be, it’s time to work on growth. Take a look at something you’d like to get better and stronger with in your office. As an example, I was going to do some work to better understand teledentistry this summer.

	Today, I’ll bet you that when summer is here, I’ll be so busy trying to catch up with treatments that have been postponed, I won’t have the free time I was counting on. However, I still want to learn more about teledentistry.
	To that end, I’m spending some of my time now to do that learning. I’ve got a training session set up with the provider TeleDent to help me learn. By the time you read this article, I should be well on my way to understanding the concept and the program much better.

	The enemy of orgaization is entropy. Things naturally go from order to disorder. That’s the law of nature. When we are busy (and before this all started, who wasn’t busy?) we don’t stay as organized as we should. As assistants and hygienists turn rooms over for the next patients, things end up being put where they shouldn’t. Often times, “I’ll put that back after the next patients,” turns into, “I’ll put that back tomorrow morning,” and it just continues to slide from there.

	Have some staff take this time to reorganizethe treatment areas so there is a place for everything and everything is in its place. That way, when we are cleared to be doing elective procedures, your office will be ready to rock. Nothing is going to throw your efficiency a curve like trying to remember where you put something 60 days ago. Take advantage of the downtime and get things squared away.

	There are always two ways to look at things. Half empty or half full, up or down, yin or yang. Despite all the negativity and stress involved with our current situation, I refuse to let this virus or the mess it’s leaving in its wake dominate me.

	I look upon this time off as a huge dam that is holding back millions of gallons of opportunity. When the floodgates open, I want to be there with a big net to scoop up all the fish. There’s plenty of room along the downstream area. Why don’t you join me? 

The Coronavirus epidemic will continue to disrupt the healthcare industry in ways we aren’t even aware of yet. 

Author | Dr. John Flucke

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