“If it keeps up, man will atrophy all his limbs but the push-button finger. ~Frank Lloyd Wright”
This last couple of weeks I spoke to many of you about the new IC protocols from the college. It’s surprising yet again to see how many really didn’t read the document! My ‘interpretation’ is pretty simple, and it based on understanding what guidelines the rest of the world is starting to use. The argument that we already do ‘good enough’ is debatable. Of course we do our best – but today is not yesterday.
When I started, many of you did too. You will remember when it was ‘good enough’ to wipe a handpiece in between patients. The turbines couldn’t stand up to sterilization. You will remember using Chemiclaves instead of Statims. No gloves….no masks….and when these regulations started to come into play – there was an attitude about change. But over time, we accept this, and realize it really is for the greater good. Has anyone gotten sick from a visit to their dentist because of lack of conformity?
There are cases that are very public that have been traced back. The truth is, it is sincerely difficult to know exactly where and when someone actually got sick. But in a clinical environment that is performing surgery I believe we are supposed to treat every patient as ‘high risk’.
Ask yourself…do you truly do that? Is a patient treated with more caution if they have TB or HEP? Would you still walk across a hall with those contaminated instruments and wear no mask and a little latex glove to scrub those instruments…or would you have a mask and heavy duty glove. Would you prefer to maybe not handle those instruments at all after the procedure opting instead for a ‘hands free’ method? Isn’t that the way all patients are supposed to be treated, as if they are all contaminated?
I would say the majority of offices DO INDEED treat every patient that way. And the guidelines we use are pretty good, but there are always people who don’t want to follow a guideline. It’s likely not you. But those few who break the rules, without a guideline, could possibly make everyone else look bad. At least having a current guideline gives an organization a publicly available document that shows in principle the organization prefers their members to follow a stricter guideline. Then if one bad apple decides they aren’t going to follow some basic rules – they are not the majority.
Most people I have met with are going to include the ‘suggested’ new rules. It’s something I have promoted for years, since it’s truly good TIMEfactors – it is efficient, safe and practical…but it’s something new to learn, and it’s definitely an investment. So here are a few suggestions – and it’s only my opinion – of what we are looking at…
#1 – Personal Protective Gear. Heavy gloves for your cleanups. Masks only in the operatory (not made to wear all day). Masks that you know the level of protection if asked (do you know?). Proper cleaning of contaminated work clothes – do you just walk out with your clothes and go for supper? Do you have an “infection control” officer in the office. Does you have a manual of IC protocols for your office that all members of your team have read, and understand and signed?
#2 – Instrument Management.
-Cassette systems to keep contaminated instruments contained from operatory to sterilization.
-Sharps containers in the operatories – nothing sharp leaves the op.
-Surfaces free of clutter in the operatories – keep everything as easy to barrier or wipe as possible.
-Disposable syringe tips (do you know that approximately 10% of syringe tips do not get completely sterilized even after going through the autoclave!! Check out Dr. Molinari article here – http://www.dentaladvisor.com/images/pdfs/reusable-versus-disposable-air-water-syringe-tips.pdf).
-Large, fast autoclaves for wrapped instruments
-ZONES within your sterilization area for contaminated, processing, and sterile
-Completely dry and bagged instruments presented to your patients
-Records of sterilization cycles logged to the day and patient if possible
#3 – Water infection control. The majority of offices have no DUWL infection control process. Many that do are not following the protocols, they are simply adding a tablet to a waterline – but not performing the regular maintenance flush, or the recommended flushes in the morning and between each patient. TEAM VISTA is a simple answer that can help meet these needs.
Digital Impressions. We have the Answers now!!
Another major shift is Digital impressioning. This technology is coming much faster and more dramatically than Digital Xray every did. The last week alone I quoted a half dozen offices on the new NEVO scanner from E4D that allows color or B/W immediate and live scanning of your prep. Intraoral, live scanning allows you a very accurate scan and immediate feedback from your lab. The turn around on crowns is almost immediate from the lab (or in your own office mill) and the accuracy is higher than current impression material methods.
Digital impressions are so accurate, and the process to completion is so good that most labs are now offering to either ‘pay’ for your impression machine (have they ever offered to pay for your impression materials?) and/or offer a hefty discount on the milled crown.
This is the future of dentistry – and its ready, and affordable NOW.
I was saying to wait for the next generation of scanners- but you don’t have to. They are here, and they are OPEN SOURCE. Your lab can accept scans from the new NEVO scanner, or the 3Shape TRIOS. The NEVO and 3M Scanners are available 4th quarter(Canada) and are $15,000 – $25,000 – These are BOTH OPEN SOURCE meaning you have an opportunity to pick your lab, or mill it yourself. Single units, multiple units, clear aligning orthodontics, appliances….you name it!!
THIS IS MAJOR NEWS. It will change how you look at iTero and Cerec who are still using closed source. That means you don’t have the option on how you mill. It’s not a bad thing, it just limits your creativity and abilities (in my humble opinion). I am a fan of open source. Bring in the competition! This is getting good!
The business opportunity for you isn’t just a reduced chair time for taking the impression. It isn’t just more accurate impressions, and less retakes. It isn’t the patient education portion as your patient watches you scan their mouth with cutting edge technology. Much easier to schedule patients for cements without a long wait. There is even more business opportunity.
The labs are offering crowns that are milled at around $200! Volume discounts are likely to follow. Milling centers are also getting to be ‘affordable’ and competitive. You will see some new players in the market offering to get you a lab in house set up at competitive rates so you can mill these yourself for under $100 total cost. Many offices are now setting up their own corporate labs and allowing the milling labs to bill their lab. They in turn bill the patient the lab fee and keep the lab markup for themselves. In essence, you can now keep the profit that the labs perhaps used to keep. Or if you feel different, pass the savings along….it’s a new world.
Phew – I had 10 minutes to do this and it took 20!!
Have a great weekend!
Smile!
Warren Bobinski
The Everything Dental Guy
Success in Dentistry and Life
TIMEfactors
