Elizabeth Nies, RDH

A hygienist’s take on Cetylite’s Cetacaine Topical Anesthetic.

Do you ever have one of those days where you look at the patients on your schedule and take a deep breath? They’re all sensitive during their hygiene visit! Ugh!

The amount of empathy I conjure up during those visits exhausts me. Often the patients who require the most from us are our biggest fans. They tell everyone they know about how they have the best hygienist in the world and would never let anyone else clean their teeth. They deserve the best you can give.

I pride myself on providing a pain-free preventative dental hygiene appointment….OK as pain free as possible. I do many things to make that happen, including offering a topical anesthetic.

In the 20th century many clinicians placed globs of greasy topical to take the edge off during instrumentation. In one office we used Cetacaine spray prior to injections for minimal discomfort. We had to use a quick blast because there was no way to control the dosage. In the early 21st century, I started using single-dose topical anesthetic and my patients loved it. Unfortunately my bottom line did not.

The anesthesia the patient received lasted long enough; I just ended up throwing more away than I used. I found myself becoming very picky regarding who I would use it on so I would not go through it so quickly. I even considered adding a fee to justify the cost. Then, while attending CareerFusion, I found out about an alternative that was less expensive but effective, allowing patients to have a pain-free visit. The best part? You control how much you use and have minimum waste so you do not have to throw unused product away.

The company is Cetylite. Their Clinical Kit contains one 30-gram bottle of 

, 100 graduated Delivery Syringes, and 100 microcapillary Delivery Syringes. This is all made possible because of its Luer-lock cap, which allows the product to be drawn into Luer-lock syringes. The syringe is graduated, according to Cetacaine Liquid dosage. Simply put, you only fill the syringe with the amount you need. They also offer the Cetacaine Liquid Chairside Kit, which contains one 14 g bottle of Cetacaine Liquid, 20 tips and syringes.

The onset is rapid, about 30 seconds, and lasts for 30–60 minutes. That means you can get to work quickly and not worry about reapplying the product during a procedure. The minimally invasive plastic tip is safer around the soft tissue. This design was created based on input of 

This sounds too good to be true, right? Well it gets even better. To use during a full-mouth procedure the cost is approximately $2 compared with the $25 it cost me before, plus the fact that I had to discard the unused portion.

Cetylite has two size bottles. One bottle contains 14 grams of Cetacaine and the other bottle contains 30 grams. The 30-gram bottle is enough for me to see 75 patients if I use it for full-mouth procedures. It usually is enough for me to use it on 75 to 150 patients because I use it for one tooth if it allows me to do a better job for my patient. Some offices use Cetacaine for all topical procedures, replacing the greasy topical they were using. I no longer have to pick and choose which patients I want to use it on because I only dispense what I need on any patient who needs it, even for one tooth.

 around crowns and bridges, especially in areas they find difficult to keep clean daily. I place a small amount of Cetacaine under the gum line and begin ultrasonic cleaning the area. The once sensitive gum tissue is easily debrided, which allows for healing to occur.
	I have seen patients’ mouths stay healthier between visits because I can do a more thorough cleaning with minimal discomfort. They no longer worry about me hurting them; they always remind me to use the good stuff! I simply smile and tell them “only the good stuff for you!”

Product Review: How to ensure your patients have a pain-free visit every time 

			A hygienist’s take on Cetylite’s Cetacaine Topical Anesthetic.			Written by: Liz Nies RDH			Cetylite’s Cetacaine Topical Anesthetic			Date published: 06/06/2013	5 / 5 stars

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Product Review: How to ensure your patients have a pain-free visit every time

Want to improve case acceptance in your practice? Check out these must-read tips.

Check in with your patients at the beginning of every appointment to find out what their long-term oral health goals are

 and what you can do to help get them there. Patients are much more comfortable talking about cosmetic desires if you bring it up.

Make your intraoral camera part of every new patient exam

. At the end of their new patient visit take them on a tour of their mouth. Remember to let the patient do the talking. By the time you get to the last photograph they will be talking about all the things they want to change.

Too often dentists assume patients aren’t accepting treatment because they can’t afford it

. While that may be part of it, fear and not understanding the treatment’s value may also play a role. Review any long standing treatment plans and ask the patient why he or she hasn’t gone forward. Address any fears they have and educate. If money is the concern, remind them the cost of fixing the problem will only increase with time.

When discussing treatment options or findings, always keep the patient in the center of it in the “power triangle.” The doctor is in front of the patient with the hygienist/assistant next to the patient on the other side. Keep eye contact so the patient can nonverbally be part of the conversation. If there are a lot of questions or if the discussion seems to be turning into a larger case, move the patient to a consultation area or make another appointment to discuss treatment.

Listen to patient cues and what they think about their smile. It’s ultimately their decision to make, so take the time to give them all their options and listen to their questions and concerns. Give them what they need to make the right decision for their overall health; don’t try to decide for them.

Want more advice on how to improve case acceptance in your practice? Watch this Morning Huddle video featuring Jameson Management:

Top 5 ways to get patients to accept treatment

Having trouble getting patients to yes? Here's how you might be sabotaging yourself.

“They are only going to do what is covered by their insurance!”

 “Don’t bother addressing that bridge we have been talking about it for years!”

“I have reviewed the hygiene patients for today and they are completed so probably not much diagnosis today.”

These assumptions are because we made ourselves the deciders. Morning huddles are a very important part of any healthy dental practice-if they are productive. The huddle is the best way to get the entire team on the same page and to review treatment that may be needed or existing treatment plans. Those assumptions hurt the bottom line.

Here are 5 things you might be doing to hurt 

1. You’re not checking in with your patients to make sure you are meeting their needs.

Simply starting a visit by letting your patients know you want to make sure you are meeting their needs is a great way to show you care.

I simply ask, “What are your long-term oral health goals?” and “How do you want your smile to look in the next 3-5 years?” I have uncovered desires for veneers, replacement of old alloys, implants, 

Cosmetic dentistry is something that our patients are just not comfortable bringing up unless asked. How many times have you heard a patient say after you recommend replacing an old PFM “Good I have always hated the way that crown looked!” That is because we never asked; we only share what 

 needs to be addressed right now. Check in with your and patients you might be surprised at what you find out!

2. You’re not using your intraoral camera. 

 on every new patients’ posterior teeth, whether they have a restoration or not. We include a photo of the lingual of their lower anterior teeth.

At the end of their new patient visit I take them on a tour of their mouth and I show them what their teeth look like today. The important thing to remember is to let the patient do the talking. Most patients think even a healthy tooth looks gross or they get flipped out by the way their teeth look. By the time you get to the last photograph they will be giving you all the things they want to change. The patient becomes the decider not us!                                                                            

3. You assume only money is keeping them from accepting treatment. 

If a patient has a long-standing treatment plan, I always make sure I review it. Too often we assume it is a money issue keeping them from yes. While that may be part of the challenge, I have found that 

By taking the time to ask patients what is preventing them from moving forward, patients will come clean on what is holding them back. For the fearful talk about nitrous, Valium, one visit or ways to decrease length of time being numb. Some offices even offer conscious sedation. Let them know other patients have been fearful too so they know they are in the right place.

If they tell you treatment time is the issue, offer fewer visits by doing more in a longer appointment. Remind them that the longer they wait the more they’ll need to have done in the future.

If it is a money issue, talk about third party financing or how dentistry does not get less expensive with time. You can even let them know that dentistry is the best health value-most dentistry lasts longer than a refrigerator.

Not sure what your patients really want? Check out this Morning Huddle video for help. 

4. You’re not keeping the focus on the patient.

Keeping the patient the center of the conversation is important and is usually one of the first things to be overlooked. Whenever you are discussing findings or information about the patient, always keep the patient in the center of it.

I call it the power triangle. The doctor is in front of the patient and the hygienist/assistant standing next to the patient on the other side.  If you keep eye contact with the patient so he can nonverbally be a part of the conversation, you will find he they may add things or even correct you.

Make sure the patient is sitting up. A supine/laying done position makes patients feel vulnerable and uneasy. If there are a lot of questions or if the discussion seems to be turning into a larger case, move the patient to a consultation area or make another appointment to discuss treatment.

While consulting with a team it became clear to me that the doctor was in his own way. He had arch photos of a patient in his 30’ that had amalgam fillings in all posterior teeth. This patient never wanted to have a dental emergency and wanted to keep his teeth and have them healthy.  The patient did not like the silver in his teeth and knew that they were 20 years old. This patient did not have a treatment plan. The doctor said the margins were great and sometimes you are opening a can worms by removing old amalgams.

I asked, “If this patient said I want all my silver fillings replaced what your answer would be?” The dentist said “we can do it.”  Many of the teeth would need inlays, onlays and crowns-a fairly big case. The problem was the dentist had become the decider on when the work needed to be done, instead of 

listening to the cues from the answers the patient had given him

. Not all patients live by the old adage,” If it ain’t broke don’t fix it” so why do we live by it?

If you want to increase case acceptance in your practice, It comes down to listening to what our patients are telling us and giving them the information they need to move forward with their treatment plans. Every team I work with is amazed when their production goes up by making these small changes. Stop getting in your own way and let the patient decide! You will love your new bottom line.

Want to get the Morning Huddle e-newsletter in your inbox every Monday? 

5 ways you’re keeping patients from accepting treatment

Year after year, survey after survey, DPR’s readers affirm that when it comes to choosing 

 for their dental practices, colleague recommendations are vital. Here, we provide space for dental professionals-like you and your team-to reflect on the products they see making a difference.

 therapy is just as rewarding for me as it is for my patients. I consider it an honor that they trust me to help bring their mouths from a diseased state to a healthy one. That is why learning new techniques and products that will assist me in treating my patients’ infections is a must.

ARESTIN is a product I go to quite often, especially in my periodontal maintenance patients. We all have those cases that seem to be going along fine. Four quadrants of periodontal therapy were completed two years ago and the patient probing depths are normal with minimal to no bleeding.

The patient has great home care and comes in every three months like clockwork. But during your full mouth probing you fall into a 7 mm pocket on the distal lingual of tooth No. 3, and there’s some bleeding. The patient hears these numbers and his or her eyes open wide as if to say “Did you say seven?”

Ten years ago I would have cleaned the area as best I could, irrigated with chlorhexidine, reviewed home care techniques and brought the patient back in two weeks to evaluate for healing. If after two weeks the pocket was still present I would then recommend either retreatment of the entire quadrant with SRP or refer the patient to a specialist. That was before ARESTIN came into my life.

What it is
	ARESTIN is an effective antibiotic treatment that comes in powder form. This powder is placed inside infected periodontal pockets just after periodontal therapy procedures. The powder contains “Microspheres,” which are tiny, bead-like particles that are smaller than grains of sand and are not visible to the eye. They are filled with the antibiotic minocycline, and they release the drug over time into the infected pocket, killing bacteria that live there. ARESTIN can continue to fight the infection for up to 21 days after mechanical debridement. Clinical studies show ARESTIN is more effective than mechanical debridement alone and significantly reduces the size of periodontal pockets compared to periodontal therapy alone.


	Today my treatment plan is periodontal therapy using code 4342, 1-3 teeth, and the placement of ARESTIN code 4381, site specific antimicrobial. I love being able to place the minocycline spheres directly into the area where the infection is located, rather than having to expose the patient to systemic antibiotics. Each dose is measured and easy to load into the specially designed syringe.

The tip fits easily under the gum and with a slight push all of the powder is plunged into the pocket. Patients are always amazed that it is administered so quickly and painlessly. I have never had a patient tell me of any post placement discomfort.


	The patient returns to our office in 3-4 weeks for an evaluation. If the pocket has healed and a normal depth is measured, I schedule a 3-month maintenance appointment. If the pocket has improved somewhat but is still red and measurable, I may opt to place another dose of ARESTIN and check again in one month to evaluate for healing. After the second placement the infection is gone and there is no longer bleeding on probing.


	I know clinicians are hesitant to recommend ARESTIN merely because most insurance companies will not cover it, but patients often decide to pay out of pocket to keep their disease under control.

The fee for ARESTIN placement varies from $35-to-$75 per site or tooth. Some insurance companies will cover it, but it is easier to tell patients they won’t. That way, they’re pleasantly surprised when they do!

When I go to offices I coach through HygieneFusion and share how to implement ARESTIN therapy, team members are amazed at how easy case acceptance is. Patients come to your office expecting the best care. They trust you to get and keep their mouths and bodies healthy. ARESTIN is a key tool in doing just that and my patients love the results they are seeing from its placement. Most practices have many patients who could benefit from ARESTIN therapy, and that benefit translates into increased production.

Our patients deserve every chance to have their periodontal disease under control and maintained. They faithfully come in for preventative appointments and expect us to offer every tool/technique available to them. It is something they will share with their friends, and their friends may just decide to see you, too!
	
	 

Year after year, survey after survey, DPR’s readers affirm that when it comes to choosing new dental products for their dental practices, colleague recommendations are vital. Here, we provide space for dental professionals-like you and your team-to reflect on the products they see making a difference.