Kristen Mott is the associate editor for Dental Products Report and Digital Esthetics.

Kristen Mott

Proper dental instrument processing is an essential function of every dental office. Instrument processing is a multi-pronged approach. According to the CDC, instruments must be cleaned and decontaminated, prepared and packaged, sterilized and then stored.

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Fortunately, companies are creating products that clean and sterilize instruments  quicker and more effectively than ever before. Cassettes made from heavy-gauge stainless steel also enhance the process and ensure that products last for years to come. From ultrasonic cleaners to autoclaves, the next few pages feature some of the top instrument processing products on the market.

• Benco’s Z3 General Purpose Tablets, once dissolved, are said to be the most convenient and safest way to clean instruments in an ultrasonic machine.
	• The patented technology gives clinicians a highly concentrated cleanser that’s safe and effortless to use.
	• No mixing or measuring is required – simply add one tablet to one gallon of water and the solution is ready.

	• Purit Clean-it is a biodegradable, ultrasonic instrument cleaner.
	• The solution is formulated with non-ionic surfactants to protect dental instruments.

• Tri-Clean™ Ultrasonic Cleaners are said to deliver the next generation of superior cleaning power.
	• Working in conjunction with Tri-Clean’s Triple Enzymatic Cleaners, the ultrasonic cleaners are designed to prolong instrument life, produce cleaner instruments and improve infection prevention.
	• Four recessed models and five tabletop models, ranging from four to 20 liters, are available, including a new 19-liter model with an 8-inch deep tank for additional cassette capacity.

	• The BioSonic UC300 features a 3-gallon tank capacity, unmatched flexibility with multiple basket and beaker arrangements, adjustable basket dividers for sorting instruments and racks to accommodate popular cassette systems.
	• The unique design of the bezel and lid is engineered to reduce noise levels for quiet operation and also limits airborne contaminates, providing a safe work environment.

	Coltene/Whaledent Inc.
	800-221-3046  |  

 Ultrasonic Cleaner family and the Resurge Instrument Cleaning Solution combine to provide modern convenience with powerful and effective cleaning performance.
	• A low-profile design allows for easy loading and unloading.
	• The flexible loading option accommodates bundles, loose instruments or cassettes - or a combination of all of the above.

	• IMS saves time by pre-sorting and organizing instruments by procedure. Once configured, the instrument setup remains complete throughout instrument reprocessing, from cleaning to sterilization to storage.
	• Instrument cassettes are placed directly in both ultrasonic washers and sterilizers, which is said to virtually eliminate the need to hand scrub while reducing the risk of potential sharps injuries.

• The Quantrex line of Ultrasonic Cleaning Systems is said to set the standard for precision cleaning, providing versatility, durability and exacting results.
	• Designed for countertop use, the Quantrex series is quiet and self-contained, and it offers a variety of sizes for every cleaning application.
	• A full line of accessories is available for all cleaning requirements.

	L&R Manufacturing Company
	201-991-5330  |  

	• The LM Dental Tracking System™ tracks and monitors instruments and materials using RFID technology.
	• Instruments, handpieces, filling materials and more from various manufacturers are wirelessly read in a few seconds.
	• Automating traceability, logistics and infection control documentation is said to allow staff to work more efficiently and focus on the patient.

• Midmark offers cabinetry that helps clinicians follow CDC guidelines, moving the flow of instruments in a single direction from dirty to sterile.
	• Midmark dental sterilizers are designed for reliability, performance and ease of use with simple, one-step loading and automatic drying.
	• With Midmark QuickClean Ultrasonic units, dentists gain a safer, more efficient work environment.

	• The Sterilization Cassettes are manufactured from heavy-gauge stainless steel for maximum durability.
	• Nordent combines an exclusive glass bead finishing process with advanced electro-polishing technology to produce a surface that’s said to provide maximum stain resistance.
	• The corner relief holes are precision engineered to evacuate liquids quickly and allow for faster processing.

	Nordent Manufacturing
	800-966-7336  |  

• Fliptop™ Cassettes are designed to provide high-quality, convenient infection management, organization and ergonomics.
	• Made from the highest quality passivated, surgical-grade stainless steel with unique Teflon double hinges, the cassette’s lid can flip up, over and under to act as its base, creating a much smaller footprint.
	• The cassette’s flow-through design is said to make it ideal for sterilization.

	Paradise Dental Technologies (PDT)
	800-240-9895  |  

	• Easyclean is designed to provide easy, intensive and gentle ultrasonic cleaning using the latest state-of-the-art technology.
	• The unit offers efficient cleaning capacity, due to optimal heat distribution with the aid of specially arranged heating elements.
	• Additional features are said to include adjustable heating and a long service life.

• BRAVO™ is a class B fractionated vacuum sterilizer that incorporates both pre-vac (to remove air) and post-vac (to ensure a dry load every time) cycles for efficient operation.
	• BRAVO™ 17V and 21V are said to be two of the fastest chamber autoclaves on the market, sterilizing and drying instruments in 35-40 minutes.
	• The unit offers a variety of filling and draining options.

	• An 8-inch deep tank allows for sterile processing of four large instrument cassettes.
	• The proprietary power-pulse signal is said to deliver best-in-class acoustic cavitation that does all the work; the formation, growth, oscillation and implosions of millions of microbubbles create violent shock waves and micro-jets of water that blast away debris.

• Available in two sizes: an 11-inch chamber and 19.8 inches deep, with five extra-large trays for pouches and packs; and a 9-inch chamber and 19.8 inches deep, with three extra-large trays.
	• A closed-door, HEPA-filtered, air-drying system is engineered to maintain sterility and ensure efficient drying of packs and pouches by ensuring that the door remains closed throughout the dry cycle.

	• The B-Lok Tray and Locking Cover are designed to work together to give the user the most efficient method of infection control.
	• After the instruments and items have been sterilized, putting them in a tray with a locking cover keeps them protected until they’re ready for the procedure.
	• After a procedure, the contaminated instruments and items may be put back into the tray with a locking cover to help prevent cross-contamination.

	Zirc Dental Products
	800-328-3899  |  

Articles

Rounding up some of the top instrument processing products on the market.

Ensuring effective dental instrument processing

	Almost every day it seems there’s a headline on America’s opioid overdose crisis. And for good reason: More than 115 people in the United States die every day after overdosing on opioids, according to the National Institute on Drug Abuse. And in October 2017, President Donald Trump declared the opioid epidemic a national public health emergency.

	The start of the opioid crisis can be traced back to the late 1990s when healthcare providers began to prescribe opioid pain relievers at greater rates, after being reassured that patients wouldn’t develop addictions. This in turn led to widespread misuse of those medications. According to the 

, roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.

	Opioids include a range of drugs, from licit prescription pain relievers like oxycodone, codeine and fentanyl to the illicit drug heroin. In addition to causing an increased overdose death rate, opioid addiction contributes to the spread of infectious diseases as well as the rising incidence of neonatal abstinence syndrome.

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	The dental industry plays a small yet significant role when it comes to the opioid epidemic. In 1998, dentists were the top specialty prescribers of opioid pain relivers, accounting for 15.5 percent of all opioid prescriptions in the nation, according to the 

. Fortunately, by 2012, this number had fallen to 6.4 percent. Nevertheless, dentists are typically one of the first medical professionals to prescribe opioids to teens and young adults for the treatment of acute pain, such as prescribing Vicodin or Percocet after wisdom teeth removal.

	“When we think about what the dentist’s role is, in my mind, we may not be prescribing that much, but we are likely to be somebody who is prescribing to a person who has never had an opioid before,” says 

, BS, DMD, MS, Ph.D., MPH, a professor at the University of Pittsburgh School of Dental Medicine and a spokesperson for the ADA. “If you’re the first prescriber, you need to stop and do some counseling, do some history taking to see if they’re at risk. And when you prescribe to an adolescent, you just have to stop and think that in adolescents, their central nervous system isn’t fully developed, and as a function of that they’re frequently risk takers.”

	In light of the growing opioid overdose crisis, the ADA this March announced a 

 to combat the opioid epidemic. The policy supports mandatory continuing education in prescribing opioids and other controlled substances; statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain; and dentists registering with and utilizing Prescription Drug Monitoring Programs (PDMPs) to promote the appropriate use of opioids.

	“As president of the ADA, I call upon dentists everywhere to double down on their efforts to prevent opioids from harming our patients and their families,” says ADA President Joseph P. Crowley, DDS, in a statement. “This new policy demonstrates ADA’s firm commitment to help fight the country’s opioid epidemic while continuing to help patients manage dental pain.”

	Dr. Moore says PDMPs have been particularly effective, especially in states that make their use mandatory.

“Starting about four years ago, states began to set up systems whereby if you have a patient come into your office who is in acute pain or is possibly in acute pain and you want to write a prescription for Vicodin, you can call a telephone number and that number has a database that can tell you whether that patient has received a Vicodin or a narcotic in the last two weeks or the last month,” Dr. Moore explains. “So, now you have some knowledge of whether this patient is doctor shopping or not.

	“About a year ago, every state has a PDMP that’s linked into pharmacies,” he adds. “The pharmacies, when they dispense an opioid, they report that they’ve just dispensed 30 tabs of Vicodin to Mr. Jones. And so now I know, when that patient comes into my office, whether this is a legitimate prescription or whether this is someone who is misusing opioids.”

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	Dr. Moore says that all dentists may not be thrilled with the ADA’s new policy, but that it’s necessary given the current state of the opioid epidemic in the country.

	“None of us want a legislator making a decision on how I’m going to treat a patient or how I’m going to write a prescription, but this addiction is pretty traumatic. It’s terrible what’s going on,” he says.

	Education and hands-on experience are critical for dental students to understand the intricacies of dentistry. Ongoing education of appropriate prescribing habits is also key. Unfortunately, pain management is a topic that has often been juggled around in dental schools.

	“The teaching of pharmacology and specifically orofacial pain management has been very variable over time and across the country,” says 

, DMD, BDS, a professor of oral and maxillofacial surgery at the Harvard School of Dental Medicine. “As CODA requirements for accreditation for dental schools have not been specific or detailed, dental schools have been left to their own devices. Pain management has rarely been taught by a specific department and has been delegated to oral and maxillofacial surgery, or other departments alone or in combination.

	“This has led to a variety of sometimes opposing approaches and conflicting attitudes,” he continues. “The specific issue of opioid prescribing has suffered the same fate until recently. The result has been that many dentists now in practice are ill prepared to deal with the prescription opioid crisis as they lack the training and knowledge base.”

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	Fortunately, dental schools across the country, in collaboration with the 

, are now addressing this issue and assessing their curricula to better prepare graduating dentists. For instance, in 

, a collaboration among the three dental schools in the state, the Massachusetts Dental Society, the state’s Department of Public Health and a student group established enhanced training for dental students in strategies to prevent prescription drug misuse. These statewide “core competencies” were said to be the first of their kind in the nation.

	“The group gathered data on what was already being done in the schools and proposed a model to address the issue in three domains,” Dr. Keith explains. “The primary preventive domain involves preventing prescription drug misuse by screening, evaluation and prevention (evaluating orofacial pain, risk assessment, use of pharmaceutical and non-pharmaceutical treatments as well as developing appropriate communication skills). Secondary prevention domain involves treating patients at risk for substance use disorders and engaging patients in safe, informed and patient-centered treatment planning. Tertiary prevention domain involves managing substance use disorders, eliminating stigma, and advancing interprofessional and interdisciplinary collaborative efforts.

	“The first two domains are most amenable to implementation in an undergraduate dental curriculum,” he adds. “Most of these improvements are already in place in the three Boston dental schools, and graduating classes are familiar with safe and effective pain management in the dental practice setting.”

	Arming graduating dentists with knowledge of pharmacology and pain management is essential and will allow them to provide appropriate treatment for patients who are in pain as well as those who are at risk of substance misuse.

	“Along with our medical colleagues, we need to take responsibility for prescribing medications that are effective, safe and appropriate to the patient’s needs,” Dr. Keith says. “This requires a knowledge of pain assessment and management and of the risks, benefits and alternatives of a variety of analgesics, including opioids and other non-pharmacologic strategies. … In time, these strategies can help improve dental pain management and reduce the number of opioid pills that are left over and that may be diverted for non-medical use.”

	While dentists are used to prescribing immediate-release opioids for the treatment of acute dental pain, new research suggests that opioids aren’t actually the most effective option. 

 published in the April 2018 issue of the 

Journal of the American Dental Association

, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are better at easing acute dental pain than opioids.

	“That article quantitatively reviews about 460 clinical trials that have involved almost 60,000 patients,” says Dr. Moore, who was the first author of the study. “The results of that say that the nonsteroidals work every bit as well as Percosets. And it also says that these narcotics are more likely to cause side effects like nausea and vomiting. I think probably the most interesting or exciting thing for me is that one realizes the most effective analgesic when you take out wisdom teeth is two Advil and one extra-strength Tylenol.”

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, DDS, MS, director of predoctoral endodontics and an associate professor in the department of endodontics at the Case Western Reserve University School of Dental Medicine and one of the study’s authors, says the new research will allow dentists to provide their patients with the best care.

	“We were interested in summarizing the data available in the medical literature comparing efficacy of medications used for relief of acute pain as well as the harms associated with the various medications,” Dr. Aminoshariae says. “We thought it was important that dentists have accurate and current information for use in clinical decision making.

	“We are confident that dentists can use the data summarized in our paper to continue providing quality care to patients,” she continues. “We hope the information will better enable them to talk with patients and explain about the benefits and harms associated with the various topics.”

	Although NSAIDs can be a substitute for opioids, Dr. Aminoshariae mentions an article published in JADA in 2016 that showed some patients may not be able to take them, such as those with kidney disease, prior myocardial infarction, NSAID-exacerbated respiratory disease or who are on antithrombotic therapy.

	“NSAIDs should be the drug of choice for pain,” she says. “However, if that is not adequate, then a combination of NSAIDs with acetaminophen would be appropriate. If this combination is still not adequate, then prescribing opioids would be the next step. It is important to start with NSAIDs because these drugs are anti-inflammatory. That means they would result in a reduction in swelling, which would decrease pain. Opioids do not have this efficacy.”

	Determining the appropriate drugs to prescribe can be a quandary for many dentists, Dr. Moore says.

	“Through three or four studies, the average number of Vicodin prescribed to a patient in acute pain coming out of a dental office or surgery is 20 tablets,” he says. “What we found is, when you prescribe it, the patient isn’t in pain. They just had their wisdom teeth taken out, for example. The dentist does 10 of these procedures a day. Three of my patients may need this Percocet, but the other seven probably don’t need it, and nonsteroidals will work terrifically. But you don’t know which three patients are going to need it, so you have to prescribe it to everyone, and there lies the hook. Because what happens to the ones you prescribe for who don’t use them at all?

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	“When you prescribe them, 20 percent of people don’t fill them or don’t use them,” he continues. “On average, they use about seven to eight pills; less than 50 percent of what you prescribe is used on average. A couple of patients will use up the whole pill box, or sometimes they’ll need a refill because they have a dry socket or something like that. But you don’t know that when the patient is walking out of the office. So, you’re kind of in a Catch-22 here.”

	Using long-acting local anesthetics can also help with patients’ pain levels.

	“After you do surgery using a regular local anesthetic, we reach in and we infiltrate around the wound with a long-acting local anesthetic,” Dr. Moore says. “That keeps you numb for six to eight hours. We give you a nonsteroidal before you leave the office, pre-emptively. We use corticosteroids to decrease the swelling and discomfort. There are a lot of strategies that are ‘opioid-sparing.’ It might not mean that you never need the opioid, but maybe 50 percent of the people who would normally don’t need it if you use opioid-sparing strategies.”

	Altering prescribing habits and pursuing continuing education courses on pain management will be crucial as the dental industry continues to battle the national opioid epidemic. Perhaps just as important are dentists’ relationships with their patients and their involvement at the community level.

	“Our role really is prevention,” Dr. Moore says. “Let’s see if we can keep you from taking this. After all, we don’t use Vicodin in Great Britain or Japan or China. Ninety percent of these immediate-acting drugs like Vicodin and Percocet are used in North America. I think our role should be not only our patients but just kind of at a community level explaining that you probably don’t need to be using these drugs. I don’t think we’ll solve the opioid problem until the community says this is not acceptable.”

Taking a look at the role the dental industry plays in the opioid overdose crisis and what dentists can do about it. 

Dentistry and the opioid epidemic: what you need to know

From dealing with a boss you hate to confronting a practice bully, here are some tips on how to handle difficult situations.

6 awkward dental office situations — and how to deal with them

	While some hygienists wake up eager to get to their dental office, others may dread spending another day at the practice and dealing with the awkward situations that are sure to ensue.

Whether you have coworkers who love to gossip or a boss who barely recognizes your presence, being faced with uncomfortable office situations can take a toll. These awkward scenarios also detract from focusing on providing the best 

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	We’ve compiled a list of six awkward - and unfortunately common - dental office situations and provided tips on how hygienists can tackle them.

	Click through the slides to get started.

	You may have read a recent article titled “How to manage an employee you hate.” Some readers wrote in saying, “I have a boss I can’t stand. Why do I do about that?” You are absolutely right. Here is a voice for those who cannot, for political reasons, speak up.

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	Let me tell you about one of my nightmare bosses. Let’s call her Corina. She was a piece of work. From my first interview, I could tell she couldn’t stand me. She knew I was a family friend of the periodontist though, which apparently made me untouchable, and she really didn’t have a choice about hiring me. Corina was irate that she had to be my direct supervisor. She turned being nasty into an art form.

	As a hygienist, the main criteria that should be reviewed when being considered for employment are the following:

			Are you compassionate about the care you provide?

			Are you a dependable employee who shows up each day ready to work?

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	Unfortunately, these key points are sometimes overshadowed by other vainer ones, and we’re not just talking about skin color. Now, the requirements can range anywhere from your body type to hair color to even how old you are. For some offices, if you’d like to know where you’ll fit in, or if you will at all, just take a quick look around. It’ll become quickly apparent.

	Bullying. We hear so much about it in the news today. It's no longer the mean boys who beat up kids for their lunch money or even the mean girls who don't invite other girls to the mall.

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	Now we have cyberbullying that has kids putting vile, vicious comments about other kids on social media sites. The word spreads like wildfire through all the “hangout” channels. It has such a negative effect on young impressionable minds, which has forced kids to change schools, drop out of school and, in some very sad cases, even led to death.

	Bullying, unfortunately, isn't limited to kids. We see many adult bullies. I don't know if adult bullies were bullies as children or if being bullied as a child caused them to grow up to be bullies; however, it seems to be getting worse in the workplace.

	Are you appreciated by your dental office? Do the doctors go above and beyond to celebrate and show they care for each individual? Does your dentist remember your birthday, hand out Christmas gifts, or dish out nice bonuses when profit goals are reached for the month? How are you shown gratitude?

	In most offices that I’ve been fortunate enough to work in, birthdays were typically celebrated with a cake of your favorite flavor, lunch at a choice restaurant and a gift certificate. It feels so nice when your office cares to celebrate you, not only for all your hard work but for just being you. This show of appreciation makes you want to go the extra mile to support your dental team and to return the favor.

	I will never forget working in an office that didn’t celebrate anything! No birthdays, no holidays - not even reaching production goals. This office was very lucrative, yet the morale among the employees was depressingly low.

	How much drama is in your dental practice?

	Do you like drama? (I do, but only if it’s on TV.) Does it make the day pass quicker? Give you a little “pick me up” when things are slow? Or, are you fed up with the drama that’s in your office? You know who I’m referring to …THE drama queens, and I’m not even talking about the patients!

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	For some of us, walking into work is like turning on the soap opera of life. You get tired of it and just want it to stop. So, what are you to do? Here are some suggestions:

	The tough economic times have affected all of us in some way, and for many this effect has come in the way of no pay increase in recent years. As news of a recovery and the “new economy” cross the news media, dental hygienists wonder where their recovery is.

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is such an uncomfortable topic for many, it remains a bone of contention in many offices.

	Here are six things for the hygiene team to consider when asking for a pay increase.

	While toothpaste is critical in the fight against plaque buildup, the simple act of brushing your teeth can cause some enamel erosion. However, more toothpastes are coming on the market that claim to protect tooth enamel, decrease sensitivity and prevent erosion.

	Are these claims to be trusted? Maybe not, according to new research.

 with the participation of a researcher supported by a scholarship from the 

 investigated the effect of different desensitizing and/or anti-erosive toothpastes on initial enamel erosion and abrasion and how the interplay of their chemical and physical factors influenced erosive tooth wear.

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	The researchers prepared 150 enamel specimens from sound human premolar surfaces that were obtained from a pooled bio-bank. The specimens were randomly distributed into 10 groups and were submitted to five erosion-abrasion cycles using nine different toothpastes and an artificial saliva group. Enamel surface loss was then calculated.

	The team discovered that all groups showed progressive enamel surface loss throughout the experiment. After five cycles, the toothpastes began to present different amounts of surface loss. According to the study, among the desensitizing toothpastes, Sensodyne Repair and Protect showed a numerically lower enamel surface loss value, but it was not different from both control groups. Blend-a-Med Pro Expert showed the highest enamel surface loss.

	As for the toothpastes that claimed to have anti-erosive properties, the researchers determined that Sensodyne Pronamel and Elmex Erosion Protection presented the lowest values, not different from the control group and with no difference between them. Regenerate showed the highest enamel surface loss values, which weren’t different from Blend-a-Med Pro Expert.

“We can conclude from this study that enamel surface loss occurred to different extents, regardless of the claim of the toothpastes (desensitizing and/or anti-erosive),” the 

. “Although some of the toothpastes showed lower surface loss, none of them was able to fully protect the enamel against ETW (erosive tooth wear). From the chemical and physical factors analyzed in the toothpaste slurries, only pH and fluoride were not significantly associated to surface loss.”

	While none of the toothpastes in the study were shown to prevent enamel erosion, late last year, 

Crest Pro-Health Advanced, Deep Clean Mint

American Dental Association Seal of Acceptance

 in the enamel erosion category. When asked about this recent study, the ADA replied, “To earn the ADA Seal of Acceptance in this category, safety and effectiveness must be demonstrated via two independent clinical studies assessing the product’s ability to prevent or reduce enamel erosion from dietary acids. The ADA supports additional research on dental erosion. Patients should talk to their dentist about what dental products will work best for their specific needs.”

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	The researchers noted that a limitation of the study was the fact that the chemical and physical factors of the toothpastes were analyzed in an in vitro model, using artificial saliva for specimen incubation and for the preparation of the toothpaste slurries. Because of this, a dilution factor was introduced to the toothpastes as well as other ion-components that would interact with the ingredients from the toothpastes.

	“We’re now working on other studies relating to dentin in order to think about possibilities, given that none of these toothpastes was found capable of preventing dental erosion or dentin hypersensitivity, which is a cause of concern,” says Ana Cecília Corrêa Aranha, a professor and co-author of the study.

Chemical and physical factors of desensitizing and/or anti-erosive toothpastes associated with lower erosive tooth wear

, an online multidisciplinary, open access journal from the publishers of Nature.

A team of researchers analyzed nine toothpastes on the market that claimed to have desensitizing or anti-erosive properties.

Study shows toothpaste alone doesn’t protect enamel or prevent erosion

	Roughly 48 percent of dental hygienists don’t feel that they’re adequately compensated for the work they perform, according to a new survey conducted by InCrowd, a market research company that provides real-time market intelligence to the life science and healthcare industries.

	Two hundred and twenty-five U.S. female dental hygienists participated in the survey. The average age of the hygienists was 52 years old and the average number of years in practice was 26.

	When asked an open-ended question about adequate compensation, one hygienist responded, “The dental field is so focused on titles that it doesn’t truly respect hygienists as much as we should be respected for the work, knowledge and experience we bring to our patients. … The payment should reflect our contribution. The payment continues to go down every year. It isn’t encouraging for recent graduates, seasoned hygienists and the field in general.”

	Another hygienist commented, “No benefits, no opportunity for 

, always being asked to do more in less time and without an increase in compensation.”

	The survey also revealed that 75 percent of the hygienists surveyed had never received a promotion during their career, and 36 percent had never received recognition for their work.

	“I sometimes feel frustrated with the stagnant nature of my job,” one hygienist responded.

	“Some doctors are selfish with their money,” said another. “I celebrated 25 years with one practice and 15 with the other and didn’t receive any acknowledgement.”

	Fifty-two percent of the hygienists surveyed said they’ve been encouraged to attend an event, talk, or conference for professional development. However, hygienists are not always compensated for doing this.

 but are not compensated for it,” one hygienist responded. “As an office, we do training together for practice development. I received a pay increase two years ago and an increase in the incentive program. At this time, there is no possibility or a promotion in the dental hygiene area.”

	Twenty-seven percent of the hygienists surveyed said they had received a pay increase within the last two years, and 34 percent responded that they had received some sort of recognition for their work. Several hygienists also noted that their offices provide generous Christmas bonuses that are not performance-based, along with paid staff meals and birthday gifts.

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The survey also asked hygienists whether they had ever experienced 

 by colleagues and/or patients at the office. About 60 percent responded that they had never experienced harassment, while 15.56 percent said they had been harassed by patients and 13.78 percent had been harassed by both patients and colleagues.

	“InCrowd ran the survey because we had heard in previous research from physicians and nurses about the 

 they had experienced in the workplace and thought that the environment for dental hygienists had not yet been delved into by other research organizations,” says Danielle Schroth, 

	“We also asked about their feelings regarding their compensation because when we asked other healthcare professionals their feelings on the matter, many were neutral to negative on what they were compensated for their work," Schroth continues. "Given many HCPs reporting hostile work environments with either verbal, sexual, or physical harassment, it seemed natural to inquire, given those hurdles, what hygienists felt about how they were compensated in relation to the environment they described.”

Lack of recognition and no opportunity for advancement were cited as major concerns.

Survey reveals 48 percent of hygienists don't feel adequately compensated

	Losing just two teeth in middle age can lead to an increased risk of cardiovascular disease, according to research presented at the American Heart Association’s Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2018.

Tulane University School of Public Health and Tropical Medicine

Harvard T.H. Chan School of Public Health

, researchers analyzed the impact of tooth loss in large studies of adults, who ranged in age from 45 to 69 years old. Participants reported on the numbers of natural teeth they had, and then in a follow-up questionnaire they reported any recent tooth loss. None of the adults had cardiovascular disease when the studies began.

	The team of researchers prospectively studied the occurrence of tooth loss during an eight-year period. They found that, among adults with 25 to 32 natural teeth at the study’s start, those who lost two or more teeth had a 23 percent increased risk of cardiovascular disease, compared to those with no tooth loss. The researchers determined that the increased risk occurred regardless of reported diet, physical activity, body weight and other cardiovascular risk factors, like high cholesterol, diabetes and high blood pressure.

	In addition, adults with less than 17 natural teeth at the study’s start were 25 percent more likely to develop cardiovascular disease.

	The team reported that there wasn’t a notable increase in cardiovascular disease risk among people who reported losing just one tooth during the study period.

	“This study highlights an interesting trend that shows that dental issues actually do play a role in coronary heart disease,” says Dr. Vincent Bufalino, a cardiologist and director of the Advocate Heart Institute in Chicago. “We’ve been looking for this association for years.”’

Lu Qi, MD, Ph.D., study author and professor of epidemiology at Tulane University, explains that past research has shown that tooth loss in middle age is likely related to inflammation, but the connection hadn’t been made until now between middle-age tooth loss and cardiovascular disease risk.

	The researchers noted that a limitation of the study was that participations self-reported their tooth loss, which could lead to some misclassification. Dr. Bufalino added that smoking is also a significant risk factor and something that should be taken into account. However, he says the study serves as a reminder for doctors to be paying more attention to oral health.

“A typical primary care doctor or cardiologist isn’t overly focused on a patient’s oral hygiene or their oral care or tooth loss,” he says. “I never ask that question. It does put a bit of a warning light out there to say we should be paying attention to this, and that folks who have had significant tooth loss, that may be contributing to their risk.”

	Patient education is also key, Dr. Bufalino says, and if patients are reaching out to specialists with concerns or if they’re referred to a cardiologist by a dentist or their primary care doctor, then there’s a greater chance that heart disease can be fixed or controlled.

	“First, it’s recognition for the public that if you’re having significant tooth loss that there could be other causes here,” Dr. Bufalino says. “Second, it’s another sign that good eating habits, controlling your blood sugar and cholesterol, stopping smoking, all of those are contributing risk factors to cardiovascular disease. So, if you have tooth loss plus those, you should recognize that you’re definitely at an increased risk and you should seek an evaluation.”

	For more information on the study, visit the 

New research shows a link between middle-aged tooth loss and an increased cardiovascular disease risk.


Can tooth loss lead to cardiovascular disease?

 Dispenser is said to be a powerful and radically new way to deliver low viscosity materials. It’s a battery-powered precision delivery system for Aquasil Ultra+ material’s low viscosity products, available in digit Power cartridges.

	Problem-solver: Developed with input from clinicians around the world, the 

 is said to tackle the key challenges present during the final impression taking procedure: access, visibility, precision, control, predictability, material waste and compliance.

Efficient: Unlike current low viscosity impression delivery systems that are built around the material and not the procedure or clinician, the digit Power Dispenser was engineered to deliver a unique pen grip design with power delivery to get clinicians up to 63 percent closer to the prepared tooth at up to 42 percent less weight and 84 percent less force requirements than traditional 50mL dispensers. It also shortens the distance between the hand and the tooth prep to just three inches. The closer proximity is designed to allow clinicians to gain more control and precision.

Related reading: A review of Aquasil Ultra+ from Dentsply Sirona

	Easy to use: From preset, built-in timers to available accessories, like a wireless foot control, clinicians have a lot of options to discover with the digit Power Dispenser and 

. Single-use cartridges simplify the procedure from material loading to waste disposal, and two convenient speeds put control at clinicians’ fingertips.

	Impressive ergonomics: Current dispensing options are often heavy and can cause physical strain. With power delivery and a unique pen grip design, the digit Power Dispenser allows clinicians to assume a more 

 position and focus on precise delivery of the wash material.

This VPS impression material delivery system delivers precision and control at clinicians’ fingertips. 

Using the digit Power Dispenser in your practice

	Roughly 3 million Americans have dental implants, and that number is expected to grow by 500,000 a year, according to the American Academy of Implant Dentistry. It should come as no surprise then that more and more companies are developing innovative dental implant systems.

These revolutionary systems allow for faster osseointegration and a more comfortable fit. What’s more, many of these systems are now interchangeable and compatible with most of the industry’s leading implant manufacturers.

	Whether you’re looking for a dental implant system for single or multiple tooth restorations, take a look at the next few pages to learn about some of the top options on the market.

	Click through the slides to see the dental implant systems.

• A hybrid implant that’s designed to offer full prosthetic versatility by utilizing the standard 3.5 internal hex.
	• The drilling sequence is engineered to be as safe and efficient as possible by matching the final sizing drill to the implant with a built-in countersink, offering a direct visual to make the drilling precise and repeatable.
	• If the bone is determined to be soft, the design of the osteotomy permits the option of using a 3.7 Tampered Implant to compress the bone.

	American Dental Implant Corp.
	800-511-0661  |  

	• The implant is comprised of plateaus, a sloping shoulder and a bacterially sealed 1.5° locking taper implant-to-abutment connection.
	• The implants now come in 5 mm and 6 mm lengths.
	• 360° of universal abutment positioning is designed to provide for the cementless and screwless Integrated Abutment Crown™, which consistently allows for a non-metallic esthetic gingival margin.

• Navident is a dynamic freehand guided surgery system for dental implantation.
	• It’s designed to accurately compare the motions of the drill to planned positions, enabling minimally invasive, precise placement of dental implants.
	• With the introduction of Trace and Place (TaP), Navident is said to have introduced a breakthrough in computer-aided implantology.
	• With TaP, the workflow is simple: take a scan, plan the case, trace the teeth to align the scan with the patient’s anatomy and place the implant.

• Designed to provide predictable care.
	• Because Dentatus Implants are among the narrowest available (1.8 – 2.8 mm), they’re often placed in a one-stage, flapless procedure - even in areas of limited space - while meeting all the established criteria for predictable survival and success.
	• The unique screw-retained abutment is designed to reduce stress on the implant and provide for easy maintenance of provisional and long-term restorations.

• Designed with a site-specific, crown-down approach based on the natural dentition.
	• The range of implant options includes straight, conical, narrow (3 mm), wide (5.4 mm) and short (6 mm) implants, along with the unique OsseoSpeed® Profile EV implant, which is anatomically designed for sloped ridge situations.
	• The site-specific restorative components as well as the patent-pending, one-position-only interface for placement of Atlantis patient-specific abutments provide restorative ease.

	Dentsply Sirona Implants
	800-531-3481  |  

	• Offering an assortment of titanium abutments, analogs, screws and more, this comprehensive line features prosthetic connections compatible with most of the industry’s leading implant manufacturers.
	• Zirlux abutments are manufactured in an ISO 13485 certified environment, ensuring each component offers tight tolerances, precision machining, state-of-the-art processing and cleaning, and extensive validation testing.
	• Uniform component cost across all systems is said to allow for predictable pricing and exceptional quality.

• Hi-Tec Implants developed eight implant systems that are engineered to be compatible and interchangeable with popular implant brands and provide the ultimate solution for every case.
	• The Interchangeable System includes implants, attachments for stabilizing dentures, straight and angulated abutments for cemented crowns and bridges, and angulated and straight unit abutments for screw-retained, full-arch restorations.

	• The AnyRidge® patented KnifeThread™ design and Xpeed® S-L-A with nano calcium ion surface treatment is said to deliver faster cell proliferation, immediate stability and faster osseointegration.  
	• The MegaISQ stability meter is designed to provide a guide for optimal loading decisions and the confidence clinicians need to load faster or immediately.
	• AnyRidge’s unique design allows for preservation of the cortical bone due to no threads on the coronal portion of the implant.

	integrated dental systems (ids)
	866-277-5662  |  

• The Trefoil system is said to represent a breakthrough in efficiency for treating endentulous patients and patients with failing dentition, enabling the fixed, definitive, full-arch restoration of the mandible in one day.
	• The Trefoil system features a pre-manufactured titanium bar, which is retained on three implants featuring the TiUnite surface that’s proven to support Immediate Function.
	• Passive fit is made possible by a groundbreaking fixation mechanism that compensates for deviations in implant placement.

	• By utilizing the Ritter SB/LA Spiral Implant System, doctors can demonstrate their commitment to excellence while increasing case acceptance, containing costs and driving new patients to their practices.
	• Each implant is precision-made in Germany from industry-grade 5 titanium alloy and features an SB/LA surface treatment.
	• A progressive thread design is engineered to support insertion stability.

• Both are self-tapping, small diameter, one-piece screw implants manufactured from titanium alloy with an acid etched surface.
	• The implants are manufactured with three body diameters - 2.1 mm, 2.4 mm and 3 mm - with available lengths of 10 mm, 13 mm, 15 mm and 18 mm.
	• The implant systems are designed for long-term as well as temporary surgical implantation to provide immediate load or delayed load of prosthetics, such as overdentures or crowns.

	• Thommen Medical is a Swiss designer and manufacturer of a dental implant system known for incredible precision and impactful design.
	• A heritage of more than 30 years of Swiss precision and innovation form the basis for the company’s products.
	• High-quality yet simple to use, Thommen Medical’s products are said to deliver predictable, esthetic results without compromise.

Taking a look at some of the top options on the market.

Rounding up the most innovative dental implant systems

	Drive down the street and you’ll most likely see a box with an Amazon logo emblazoned on it sitting on one of your neighbor’s front steps. Since its humble beginnings in 1994, Amazon has grown to be one of the biggest e-commerce sites in the world. There are reportedly 80 million Amazon Prime members in the United States, according to Time.com.

 in 2015, a marketplace for business customers that offers business-only pricing and selection, analytics tools and free two-day shipping on qualifying orders. Those working in the education, government and healthcare industries - including dentists - can simply sign up for a free account to access hundreds of millions of products. Amazon Business now serves more than 1 million customers in the U.S. and has over 85,000 business sellers.

“Amazon Business was started because we heard from business customers that they love the convenience of shopping online and want an experience at work that is similar to how they shop at home,” says

Serving more than 1 million customers in the U.S., Amazon Business is changing the way dentists think about purchasing dental supplies.